Prescription Drug Plan

CVS/Caremark Prescription Drug Plan

Baylor University's prescription benefit program is administered by CVS/Caremark, a leading national provider of prescription drug benefit management programs and services. The program is designed to assist in obtaining your prescription drug needs while providing cost-effective prescription choices. The prescription drug plan is available to regular full-time faculty/staff who are enrolled in the PPO Blue Choice medical plan and the PPO +HSA BlueEdge medical plan. If you are not enrolled in one of the medical plans, you and your eligible family members may enroll during Open Enrollment, which begins November 1 and continues through November 30 for coverage effective January 1 of the following year. Medical enrollment can be requested during the calendar year due to a qualifying event that is consistent with the request for enrollment.

Retail Pharmacies - Prescriptions may be filled at all participating pharmacies. A reimbursement claim can be submitted to CVS/Caremark if a pharmacy charges the member full cost for a prescription.

Mail Service Program - The CVS/Caremark Mail Service Program provides a convenient and cost-effective way to obtain long-term, maintenance drugs. Complete the mail service order form and send to CVS/Caremark, along with your original prescription(s) and the appropriate payment for each prescription. You should receive your prescription within 10 to 14 calendar days after CVS/Caremark receives your order. Remember, enrollment in the PPO +HSA medical plan requires you to meet the deductible and then pays a percentage of the total drug cost.

CVS/Caremark Primary Drug List - The CVS/Caremark Primary Drug List is available at the Caremark website. You will need to register the first time you visit Caremark to access the primary drug list, to view your personal prescription history or to request mail service refills. To register for member access, click the "Not Registered?" link and complete the information as requested. To view the CVS/Caremark Prescription Exclusion list, click here.

Costs

Baylor University and regular full-time faculty/staff share in the cost of medical premiums (the prescription drug plan is covered under medical premiums) to cover the employee and their eligible family members. For additional information see the Prescription Benefit Plan Information website.

Step Therapy Program - Step therapy is a clinical tool used in your prescription benefit to promote the use of safe, effective and clinically appropriate medications. Your good health remains the top priority. This tool can facilitate optimal health and lower costs. The generic step therapy program requires patients to try a generic alternative medication that is safe and equally effective before a brand name medication is allowed to be paid through Baylor's prescription insurance benefit. If you choose the generic medication option, you may benefit by having a lower payment. The University may also benefit because the overall cost of the generic medications are usually lower than the brand medication option. Lower overall annual costs can translate into smaller annual premium increases which benefit everyone.

When filling prescriptions for patients, the pharmacist runs the prescription through the system. If the patient history shows that the generic drug was previously dispensed, then the brand or higher cost medication can be dispensed. However, if there is no record of a generic drug being dispensed previously, then the patient must try the generic first or go through the prior authorization process. Prior authorization is a process where the patient's doctor submits a medication request form stating the reason why the patient must have the brand name drug without going through the step therapy process. Step therapy and prior authorization are clinical tools that balance patient access to appropriate medications, appropriate medication utilization, and cost savings for the patient and for you and Baylor. Not all medications are included in the generic step therapy program. For the generic step therapy drug list, click here.

Specialty Guideline Management Program - CVS Caremark Specialty Pharmacy Services is the University's exclusive provider for specialty drugs. This program is designed to provide convenient delivery of specialty drugs, while offering personalized service and educational support for your therapy. Specialty drugs are used in the management of specific chronic and/or genetic conditions and often include injectable or infused drugs, but may also include oral drugs. The CVS Caremark Specialty Guideline Management Program also supports safe, clinically appropriate and cost-effective use of specialty medications. A clinical review will be conducted by CVS medical personnel in conjunction with your doctor to ensure you receive the best approach to your therapy. Your positive cooperation with this program can make it effective for you as well as Baylor's group plan. To view the CVS Specialty Drug List, click here.



CVS / Caremark Customer Service

Phone: 1-866-260-4646
Website: CVS / Caremark