High Option Plan

Rx Drug Benefits

 

Prescription Cost Calculator | Prescription Cost Calculator (When Medicare is Primary Payor) | Locate a Network Retail Pharmacy | Formulary Drug List

Prior approval is required for certain specialty drugs including biotech drugs. Call Caremark Specialty Pharmacy Services at 800-237-2767 to obtain approval.

The NALC Prescription Drug Program: A Convenient Money-Saving Way To Fill Your Prescriptions.

Say good-bye to claim forms and runaway prescription costs! The NALC Health Benefit Plan has two easy choices for your prescription needs, both designed to save you time and money.

Refer to the 2019 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2019 Prescription Program,  2018 Prescription Programs, and 2018 brochure are also available.

Your 2019 Drug Cost-Share When NALC is Primary Carrier
Generic Drug*: You Pay:
Network Retail up to 30 day supply 20% of Cost
Mail Order up to 60 day supply $8
Mail Order 61 - 90 day supply $12 ($8 generic for asthma, diabetes & hypertension)
Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 30% of Cost
Mail Order up to 60 day supply $43
Mail Order 61 - 90 day supply $65 ($50 Formulary brand for asthma, diabetes & hypertension)
Non-Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 45% of Cost
Mail Order up to 60 day supply $58
Mail Order 61 - 90 day supply $80 ($70 Non-formulary brand for asthma, diabetes & hypertension)

Specialty Drugs: Require Prior Approval and we utilize the NALC's Advanced Control Specialty Formulary

(Available only through Caremark Specialty Pharmacy Mail Order)

You Pay:
Mail Order up to 30 day supply $150
Mail Order 31 - 60 day supply $250
Mail Order 61 - 90 day supply $350
* Generic drug coverage shown above for those generic drugs not available at a reduced cost as listed on our NALCSelect, NALCPreferred, or NALCSenior Generic Drug Lists.

 

Your 2019 Drug Cost-Share When Medicare Part B is Primary
Generic Drug*: You Pay:
Network Retail up to 30 day supply 10% of Cost
Mail Order up to 60 day supply $4
Mail Order 61 - 90 day supply $6 ($4 generic for asthma, diabetes & hypertension)
Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 20% of Cost
Mail Order up to 60 day supply $37
Mail Order 61 - 90 day supply $55 ($40 Formulary brand for asthma, diabetes & hypertension)
Non-Formulary Brand Drug: You Pay:
Network Retail up to 30 day supply 30% of Cost
Mail Order up to 60 day supply $52
Mail Order 61 - 90 day supply $70 ($60 Non-formulary brand for asthma, diabetes & hypertension)

Specialty Drugs: Require Prior Approval and we utilize the NALC's Advanced Control Specialty Formulary

(Available only through Caremark Specialty Pharmacy Mail Order)

You Pay:
Mail Order up to 30 day supply $150
Mail Order 31 - 60 day supply $250
Mail Order 61 - 90 day supply $350

* Generic drug coverage shown above for those generic drugs not available at a reduced cost as listed on our NALCSelect, NALCPreferred, or NALCSenior Generic Drug Lists.

Specialty Drugs

Specialty drugs generally include, but may not be limited to, drugs and biologics (medicines created from living cells culltered in a laboratory) that may be complex to manufacure, can have routes of administration more challenging to administer (injectable, indused, inhaled, topical, and oral), may have special handling requirements, may require special patient monitoring, and ma have special programs mandated by the FDA to control and monitor their use. These drugs are typically used to treat chronic, serious, or life-threatening conditions, examples of such conditions include, but are not limited to, myelogenous leukemia (AML), cancer, Crohn's disease, cystic fibrosis, growth hormone disorder, hemopilia, hepatitis C, HIV, immune deficiences, multiple sclerosis, osteoarthritis, psorisis, and rheumatoid arthritis. Specialty drugs are ofen priced much highe than traditional drugs.

Note: Decisions about prior approval are based on evidence-based guidelines developed by CVS Caremark®'s pharmacy clinical team and include, but are not limited to, FDA approved indications and/or independent expert panels.

 

Advanced Control Specialty Formulary | Medications ONLY available through CVS Caremark Specialty Pharmacy | Formulary Drug List


NALC Preferred Generics


You can obtain a 90-day fills of thousands of generic drugs available through the CVS Maintenance Choice Program and through our Caremark mail order program for only $7.99 when we are your primary payor, and for only $4 when Medicare Part B is the primary payor. Call Caremark at 800-933-NALC (6252) to find out if your generic medication is currently available on our NALCPreferred generics list.


Cost-Free Generics at Retail When Medicare Part B Is Primary

Our 2019 NALCSenior Antibiotic generic list offers prescription generic medications at no cost when a 30-day supply is purchased at a local NALC Preferred or CareSelect pharmacy, and Medicare Part B is the primary payor.


2019 NALCSELECT Generic List
              
When a generic medication is appropriate, ask your physician to prescribe a generic drug from our NALCSelect generic list. The amount you pay for a 90-day supply of an NALCSelect generic medication purchased through our mail order program, or at a CVS Caremark Pharmacy, including Longs Drugs, through our Maintenance Choice Program is just $5 or $4 when Medicare Part B is your primary carrier.   

 
Smoking Cessation

When you’re ready to quit smoking the Plan can help.  You will pay nothing for FDA-approved prescription medications prescribed for smoking cessation.  These medications will be available to you at any NALC Preferred or NALC CareSelect retail pharmacy or through our Caremark mail order program. 

Drug Program: For Your Short-Term And Immediate Prescription Drug Needs

NALC Participating Network Pharmacies

The NALC CareSelect Network is a nationwide pharmacy network that offers over 69,500 retail pharmacies. Our network includes most large retail chain drug stores. In many cases, your current pharmacy already participates. Locating a participating pharmacy near you is easy—simply call 800-933-NALC (6252).

There are no claim forms to file and no waiting for reimbursement when you purchase your prescriptions at a network pharmacy. Using your NALC Health Benefit Plan identification card, you can purchase up to a 30-day supply of covered medication, plus one refill. You will pay 20% of cost for generic medications and 30% of cost for formulary brand medications. When Medicare Part B is your primary payor, you will pay nothing for (up to) 30-day fills of generic drugs available on our NALCSenior Antibiotic generic list, and just 10% of cost of other generic medications and 20% for formulary brand medications. There is no deductible associated with our Prescription Drug program.

Mail Order Drug Program:  For Your Long-Term And Ongoing Prescription Drug Needs

Your savings begin with the very first prescription you order because there are NO claim forms to submit, and NO waiting for reimbursement. For prescriptions that are not listed on either our NALCPreferred or NALCSelect generic lists, you pay $8 generic and $43 brand name for up to a 60-day supply.  You pay $5 for a 90-day supply of NALCSelect generics or just $7.99 for a 90-day supply of NALCPreferred generics.  You pay $12 for other generics and $65 formulary brand name for up to a 90-day supply.

When Medicare Part B is your primary payor, you pay $4 generic and $37 brand name for a 60-day supply.  You pay $4 for a 90-day supply of NALCSelect or NALCPreferred generics. You pay $6 for other generics and $55 formulary brand name for a 90-day supply.

Maintenance Choice Program

You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS Caremark® Pharmacy or Longs Drugs through our Maintenance Choice Program. You will pay the applicable mail order copayment for each prescription purchased.