Your Prescription Drug Out-of-Pocket Costs

Enrolled in the HRA, HSA, or FSA?

Use your Health Care Fund FSA (flexible spending account), HRA (health reimbursement arrangement), or HSA (health savings account) money toward your prescription drug expenses.

  • With the HRA and FSA, use Your Spending Account™ card to pay at the point of service or when you receive a bill. You can also pay the expense, and file an FSA claim later.
  • With the HSA, you can pay by writing a check or using your HSA card.

To find out what your prescription drugs will cost, contact CVS Caremark by calling 1-888-291-6372 or by going to


General information about your out-of-pocket costs:

  • Your annual prescription drug deductible (combined for retail pharmacy and Mail Order) applies only to Brand 50/50 drugs. The deductible is $50 for an individual and $100 for families.

  • After you meet any applicable deductible for your prescription drugs, you pay a coinsurance amount. The amount you pay depends on the coverage category for your drug (Generic, Brand 80/20, or Brand 50/50).

  • If you use a brand-name drug when a generic equivalent is available, the Plan pays only the cost that would apply if you chose the generic drug. You pay the generic coinsurance plus the difference in cost between the brand-name and generic drugs.

  • If you fill your prescription for a maintenance medication more than three times at your retail pharmacy, you'll pay 10% extra. Avoid the extra costs by using the mail-delivery service, and get your generic maintenance drugs for free!

  • Your maximum coinsurance does not apply to any extra costs if you choose a brand-name drug over a generic or purchase a maintenance drug at a retail pharmacy instead of by mail delivery.

  • If your doctor believes that a brand-name medicine is medically necessary for you instead of the generic equivalent, your doctor can provide clinical reasons to the CVS Caremark Prior Authorization Department at 1-888-413-2723. If the brand-name drug is approved, you'll pay the brand-name drug coinsurance.

  • The Prescription Drug plan includes an out-of-pocket maximum. If your eligible out-of-pocket expenses reach the out-of-pocket maximum, the Plan pays 100% of your covered prescription drug expenses for the rest of the calendar year.


Note: participants in a Health Savings Account (HSA) plan must meet the HSA deductible before benefits are paid.