Prescription Drug Coverage for Purdue Medical Plans
To determine pricing and which category a specific medication falls within, check the CVS Caremark pricing tool.
|Click links below to see prescription price prior to meeting your deductible.||Click links below to see prescription price after meeting your deductible.|
|Premier Plan CDHP||Before deductible is met||After deductible has been met|
|Standard Plan CDHP||Before deductible is met||After deductible has been met|
|Limited Plan CDHP||Before deductible is met||After deductible has been met|
|J-1 Visa||Before deductible is met
(prescription drugs do not apply to deductible for this plan)
|2021 Prescription Drug Coverage||Premier, Standard & Limited CDHPs|
|Retail (30-day supply)*||Mail Order (90-day supply)|
|Generic||Preventive||100% coverage||100% coverage|
|Non-preventive||Deductible, then actual cost up max of $10||Deductible, then actual cost up max of $20|
|Preferred Brand Name||Preventive||No deductible, 35% to max of $50||No deductible, 35% to max of $100|
|Non-preventive||Deductible, then 35% to max of $50||Deductible, then 35% to max of $100|
|Non-Preferred Brand Name||Preventive||No deductible, 50% up to max of $75||No deductible, 50% up to max of $150|
|Non-preventive||Deductible, then 50% up to max of $75||Deductible, then 50% up to max of $150|
|Specialty Rx||Deductible then 55% up to max of $250 max||Deductible then 55% up to max of $250 max|
When you enroll in a Purdue medical plan, you can receive prescription medications through a CVS Caremark participating retail pharmacy or through the CVS Caremark mail order program. To find a list of CVS Caremark participating retail pharmacies, use the Pharmacy Locator.
When using a CVS Caremark participating retail pharmacy, prescription medications are filled for a 30-day supply.
You will now have two options when you need a to fill a maintenance medication. Maintenance medications are commonly used to treat chronic conditions and taken daily over a long period of time.
CVS maintenance 90-day option – With this option, certain maintenance medications can be filled at any CVS retail pharmacy (including those located inside Target stores) at the same discounted price as mail order. The CVS Caremark extended payment option will not be available at the retail pharmacy.
CVS Caremark mail order – With the mail order you can receive up to a 90-day supply of your medication conveniently delivered through the mail at a discounted price. The CVS Caremark discreet packages are tamper-proof, weather-proof and temperature controlled, so it’s a safe option for you.
Since your prescription will need to be delivered through the mail, you will need to allow time for your medication to arrive. If you have a new medication, you may need to ask your doctor to write two prescriptions — one for a 30-day supply that you can have filled right away at a retail pharmacy and one for a 90-day supply that you can send to the mail order program.
Send your prescription to the mail order pharmacy service with a completed Mail Order Form and your copayment. To know how much copayment to include, call the mail order service for an estimate. You can expect to receive your medication in 7 to 14 days from the date you mail your order. For an additional charge, you can choose next-day or second-day delivery. Refills are even easier. You can either call the toll free number on your prescription label, 866-234-7061, or log on to the CVS Caremark website.
To transfer current retail prescriptions to mail order, log on to the CVS Caremark website and choose the medication(s) you want to transfer. Confirm the prescribing doctor information so that CVS Carmark can contact your doctor about transferring the prescription to a 90-day mail order prescription. Once your doctor approves, you can expect to receive your medication within 7-14 days. Be sure you have enough medication on hand before transferring to mail order.
Generic preventive drugs
Generally, preventive drugs are prescribed to prevent the occurrence of a disease in someone who has developed risk factors or to prevent the reoccurrence of a disease from which the individual has recovered. Generic forms of these medications are covered at 100 percent by all Purdue medical plans.
When a drug company's patent on a particular drug expires, other companies are then free to begin producing the exact same drug, but can't use the original brand name. The other companies refer to the drug by its chemical, or generic, name. Generic drugs contain the exact same active ingredients as the brand name drug and must pass U.S. Food and Drug Administration standards for safety and effectiveness. Generic drugs generally cost 25 percent to 60 percent less than the brand name equivalent. Using generics saves money for you and the medical plan.
Preferred brand name drugs
Drugs on the preferred list are brand names that have been identified as excellent values, both clinically and financially. Before a drug can be designated as a preferred brand name, a committee of independent doctors and pharmacists evaluates the drug to be sure it meets standards for safety, effectiveness, and cost.
Non-preferred brand name drugs
Some brand name drugs cost more than others, even though they have the same therapeutic effects as less expensive brand name drugs. These more expensive drugs are on the “non-preferred brand name drug” list.
Drugs in this category are typically high cost medications that require special handling, administration or monitoring. These medications require prior authorization and must be ordered through the specialty pharmacy. Drug manufacturers often offer a copay assistance program with specialty medications. If you take advantage of a copay assistance program, keep in mind that only the amount you pay applies to the deductible and out-of-pocket maximum.
- Humira costs $2,700 per fill.
- The manufacturer copay assistance program covers the drug with only a $5 copay.
- Only the $5 applies to the deductible and out-of-pocket maximum.
Most copay assistance programs have a limit, typically only covering a certain amount of doses. Once the copay assistance amount is exhausted, you will pay the full amount of the drug until your deductible is met. Then, once your out-of-pocket maximum for the year is met, prescription and eligible medical expenses will be covered in full by Purdue.
www.CVSspecialty.com or 1-800-237-2767.
Copay Installment Program
CVS Caremark offers an option to make installment payments on mailorder. The program allows you to pay for your mail order prescriptions over 90 days. To enroll in the program, go to the CVS Caremark website or call 800-234-7061 for more information. Certain limits apply.