Prescription Drug Plan

Baylor University's prescription drug benefit plan is administered by CVS/caremark, a leading national provider of prescription drug benefit management programs and services. The plan is designed to assist members in obtaining prescription drugs with cost-effective prescription choices. The prescription drug plan is available to regular full-time faculty/staff that are enrolled in the PPO Blue Choice medical plan or the HDHP + HSA medical plan. Eligible faculty/staff and eligible dependents not enrolled in one of the medical plans may enroll during open enrollment with coverage beginning January 1 of the following year. Medical plan enrollment can be requested during the calendar year due to a qualifying life event that is consistent with the request for enrollment.

Retail Pharmacies - Prescriptions for up to a 30-day supply may be filled at 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 prescription drugs. Members complete the mail service order form and mail to CVS/caremark, along with the original prescription(s) and the appropriate payment for each. Prescription orders are generally received within 10 to 14 calendar days of CVS/caremark’s receipt of the order. Quicker service can sometimes be expected when orders are placed online or by phone. Remember, enrollment in the HDHP + HSA medical plan requires deductible be met before the plan pays a percentage of the total drug cost.

Voluntary Maintenance Choice - Members can purchase a 90-day supply of maintenance prescription at a retail CVS pharmacy and receive mail service pricing.

CVS/caremark Primary Drug List - The CVS/caremark Primary Drug List is available at the CVS/caremark website. To access the list, members will register when initially visiting the CVS/caremark website. Upon registration, members can view their personal prescription history, request refills and more.

Costs - Baylor University and benefit eligible faculty/staff share in the cost of medical premiums, which includes the prescription drug plan. For additional information see the Prescription Benefit Plan Information website.

Step Therapy Program - Step therapy is a clinical tool used in the prescription benefit to promote the use of safe, effective and clinically appropriate medications. 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. Choosing the generic medication option may result in a lower payment. The University may also benefit because the overall cost of the generic medications are usually lower than the brand name 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 Baylor. Not all medications are included in the generic step therapy program.

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 the patient’s 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/caremark medical personnel in conjunction with the doctor to ensure the patient receives the best approach to therapy. Positive cooperation with this program can make it effective for everyone.

Specialty Preferred Drug Strategy - Some patients are "grandfathered" as current specialty drug utilizers. Future utilizers of select specialty drug classes will be asked to try a preferred product first. This helps members and the plan save money.

Compound Medication strategy - A prior authorization is required on any compound medication over $300. This prevents split-billing from occurring and protects members and Baylor from an area of potentially and unnecessarily high pharmacy pricing. Other restrictions may apply.