Save as PDFPrescription Benefits
Save as PDFPlan Choices
Your benefits plan includes a shared out-of-pocket max between your health and prescription plans. That means all your prescription medications will now count towards your medical plan’s annual out-of-pocket max.
Please refer to the plan details and documents below for more information on what is covered with your chosen medical plan.
Option 1
Essential PPO Plan
Plan Details
GENERIC (retail/mail)
$10 / $25 Copay
Brand Pref (Retail / Mail)
30% ($100 / $250 Max)
Brand Non (Retail / Mail)
40% ($150 / $375 Max)
Specialty
30%, No Deductible
Option 2
Protect PPO Plan
Plan Details
GENERIC (retail/mail)
$10 / $25 Copay
Brand Pref (Retail / Mail)
20% ($100 / $250 Max)
Brand Non (Retail / Mail)
30% ($150 / $375 Max)
Specialty
20%, No Deductible
Option 3
Advantage HSA Plan
Plan Details
GENERIC (retail/mail)
10% After Deductible
Brand Pref (Retail / Mail)
10% After Deductible
Brand Non (Retail / Mail)
10% After Deductible
Specialty
10% After Deductible
Your Cost of Care
Prescription drug coverage is included in your medical plan premiums.
Apps
CVS Caremark
The CVS/caremark™ app lets you refill mail service prescriptions, track order status, view prescription history and more. You must have CVS/caremark prescription benefits to use the app: If you’re not sure, check your health insurance plan information to confirm.
Learn More
Documents
07-2025 CVS Caremark Advanced Control Specialty Formulary Drug List
Prescription Benefits
07-2025 CVS Caremark Performance Drug List
Prescription Benefits
2025 Medicare Part D Creditable Coverage Notice (English)
Prescription Benefits, Retiree Benefits
Aviso de cobertura acreditable de Medicare Parte D 2025 (español)
Prescription Benefits, Retiree Benefits
Spanish
CVS Caremark No-Cost Preventive Services List
Prescription Benefits
LGBTQ Benefits Guide
Domestic Partner Allowance, Employee...
Performance Drug List – Standard Control
Prescription Benefits