Non-medicare Retiree Pharmacy
For assistance locating a pharmacy near you, prescription denials or copay questions, speak with a personal Care Coordinator at 833-740-3258 or CVS at 800-318-2572, or visit Caremark.com.
Pharmacy coverage
Prescriptions will be filled automatically with a generic drug if one is available, unless your doctor completes CVS Caremark’s Coverage Exception Request form and it is approved.
Note: It is not enough for your doctor to note “dispense as written” on your prescription; a separate form is required. If you request a brand-name drug instead of a generic alternative without obtaining a coverage exception, you will pay the generic drug copay PLUS the difference in cost between the brand and generic drug.
Note: It is not enough for your doctor to note “dispense as written” on your prescription; a separate form is required. If you request a brand-name drug instead of a generic alternative without obtaining a coverage exception, you will pay the generic drug copay PLUS the difference in cost between the brand and generic drug.
Certain chronic and/or genetic conditions require special pharmacy products (often injected or infused). The specialty pharmacy program provides these prescriptions along with the supplies, equipment, and care coordination needed to take the medication. Call (800) 237-2767 for information.
A drug’s tier is determined by CVS Caremark’s Pharmacy and Therapeutics Committee. The Committee may change the tier placement of a drug if new generics have become available, new clinical studies have been released, new brand-name drugs have become available, etc.
If your doctor believes a non-preferred brand-name drug is medically necessary for you, they will need to complete the Coverage EXCEPTION REQUEST FORM and fax it to CVS Caremark. If approved, you will pay the preferred brand copay amount.
If your doctor believes a non-preferred brand-name drug is medically necessary for you, they will need to complete the Coverage EXCEPTION REQUEST FORM and fax it to CVS Caremark. If approved, you will pay the preferred brand copay amount.
When you fill a prescription for a specialty drug, you will automatically be enrolled in a PrudentRx program that reduces your out of pocket cost to $0. You can choose to opt out of this program during Open Enrollment. Opt out form
If you or your family member takes a maintenance medication, you are required to get your maintenance prescriptions as 90-day fills. You can get your first 30-day fill of a new medication at any participating pharmacy. After that, your two choices are:
- Fill your medication at a pharmacy that participates in the State’s Maintenance Drug Network (see the LIST OF PARTICIPATING PHARMACIES), or
- Receive your medication through the CVS Caremark mail-order pharmacy.
Starting July 1, 2023, medications prescribed for weight loss or weight management will only be covered if they are prescribed by a Flyte or CT Children’s provider. Flyte is a medical weight loss program offered to eligible State health plan members and their enrolled family members. More Information
PHARMACY cost comparisons
Prescription benefits are the same across all medical plans. There is a 4-tier copay structure. The amount you pay depends on whether your prescription is for a generic drug, a brand-name drug listed on CVS Caremark’s preferred drug list (the formulary), or a non-preferred brand-name drug.
Prescription Copay by Group
For Groups 5-9
| Prescription Drugs | Non-Maintenance Drug (Up to 90-day supply) | Maintenance Drug (90-day supply) | HEP Enrolled Chronic Conditions |
|---|---|---|---|
| Tier 1: Preferred generic | $5 | $5 | $0 |
| Tier 2: Non-preferred generic | $10 | $10 | $0 |
| Tier 3: Preferred brand-name | $25 | $25 | $5 |
| Tier 4: Non-preferred brand-name | $40* | $40* | $12.50 |
*$25 if your physician certified the non-preferred brand-name drug is medically necessary
For Group 4
| Prescription Drugs | Non-Maintenance Drug (Up to 90-day supply) | Maintenance Drug (90-day supply)* | HEP Enrolled Chronic Conditions |
|---|---|---|---|
| Tier 1: Preferred generic | $5 copay | $5 copay | $0 copay |
| Tier 2: Non-preferred generic | $10 copay | $5 copay | $0 copay |
| Tier 3: Preferred brand-name | $20 copay | $10 copay | $5 copay |
| Tier 4: Non-preferred brand-name | $35 copay | $25 copay | $12.50 copay |
*You are not required to fill your maintenance drug prescription using the maintenance drug network or CVS Caremark Mail Order. However, if you do, you will get a 90-day supply for a $0 copay.
For Group 3
| Prescription Drugs | Non-Maintenance and Maintenance Drugs (90-day supply) | Caremark Mail Order Maintenance Drug Network (90-day supply)* | Out of Network Prescription |
|---|---|---|---|
| Tier 1: Preferred generic | $5 copay | $0 copay | 20% of prescription cost |
| Tier 2: Non-preferred generic | $5 copay | $0 copay | 20% of prescription cost |
| Tier 3: Preferred brand-name | $10 copay | $0 copay | 20% of prescription cost |
| Tier 4: Non-preferred brand-name | $25 copay | $0 copay | 20% of prescription cost |
*You are not required to fill your maintenance drug prescription using the maintenance drug network or CVS Caremark Mail Order. However, if you do, you will get a 90-day supply of maintenance medication for a $0 copay.
For Groups 1 & 2
| Prescription Drugs | Non-Maintenance and Maintenance Drugs (90-day supply) | Caremark Mail Order Maintenance Drug Network (90-day supply)* | Out of Network Prescription |
|---|---|---|---|
| Tier 1: Preferred generic | $3 copay | $0 copay | 20% of prescription cost |
| Tier 2: Non-preferred generic | $3 copay | $0 copay | 20% of prescription cost |
| Tier 3: Preferred brand-name | $6 copay | $0 copay | 20% of prescription cost |
| Tier 4: Non-preferred brand-name | $6 copay | $0 copay | 20% of prescription cost |
*You are not required to fill your maintenance drug prescription using the maintenance drug network or CVS Caremark Mail Order. However, if you do, you will get a 90-day supply of maintenance medication for a $0 copay.
Sign in at Caremark.com and use the Check Drug Cost tool to see the cost of your medication(s), plus any lower-cost options. These costs will depend on several factors, including where you are with your deductible.
You will pay 20% of the Rx cost if you use an out-of-network pharmacy. Find a pharmacy near you in the Maintenance Drug Network.
Pharmacy Plan Document/Forms
- Quarterly Performance Drug List
- Prescription Plan Document (English) (Spanish)
- FORMULARY EXCEPTION PRIOR AUTHORIZATION REQUEST FORM OCTOBER 2017
- CVS/CAREMARK MAIL SERVICE ORDER FORM OCTOBER 2017
Benefits Enrollment