EIU Benefit Services

Prescription Drug Plan

Health plan participants (members and dependents) are required to pay a prescription deductible each plan year.

Plan participants enrolled in any of the State health plans have prescription drug coverage included in their health plan benefits. Prescription benefits are administered by the health plan's prescription benefit manager (PBM).

Members who use the PBMs pharmacy network to obtain their medication will be charged the applicable prescription copayment after the prescription deductible has been met. A pharmacy that is not in the network may charge more than the copayment amount; therefore, members should verify that a pharmacy is in network in order to avoid high prescription costs.

CVS/caremark

Only applies to OAP and QHCP 

Self-insured managed care plans (i.e., HealthLink OAP and Aetna Health Care OAP) and the Quality Care Health Plan (QCHP) have prescription benefits administered through the prescription benefit manager (PBM), CVS/caremark. Prescription benefits are independent of other medical services and are not subject to the medical plan year deductible or out-of-pocket maximums.

Two important notes regarding this coverage are:

1. over-the-counter drugs are not covered, even if purchased with a prescription, and 
2. if a plan participant elects a brand name drug and a generic is available, the plan participant must pay the cost difference between the brand product and the generic product, in addition to the brand copayment.

Pharmacies that contract with CVS/caremark and accept the copayment amount are referred to as network pharmacies. Plan participants should use a pharmacy network for prescriptions whenever possible to yield the most economical benefit.

Links to network lists and mail order forms are below:

• CVS/caremark Member Portal  (maximum fill is a 60-day supply)
• Maintenance Medication Network (maximum fill is a 90-day supply)
• CVS/caremark Mail Order Form (form to be completed by participant for current prescriptions)
• CVS/caremark Mail Order Form - Spanish (form to be completed by participant for current prescriptions)

Plan participants who either:

1. did not have their eligibility verified at the time they purchased medication or
2. purchased their medication at an out-of-network pharmacy may file a request for reimbursement of eligible charges by filing a CVS/caremark Claim Form / CVS/caremark Claim Form - Spanish.

Contact Information