Prescription Drug Coverage
Caremark Prescription Drug Plan
Prescription drug coverage is provided through Caremark for Plans A, B and C, and its cost is included in the health plan rates. While the Preferred Drug List (PDL) is the same for all plans, the amount you pay will vary depending on the plan you select as explained below.
- Plan A and Plan B. Under these plans, generally you pay a coinsurance for your prescription drug costs throughout the year, up to a combined coinsurance maximum of $2,750 for single and $5,500 for member with dependent coverage per year.
- Plan C. Until you reach the deductible, you will pay 100% of the discounted cost for your prescriptions when you present your Caremark ID card. Once you have reached your annual health plan deductible, covered prescriptions are paid in full by the plan when a network pharmacy is used. Remember, you can use the funds in your HSA to help pay for prescription costs applied to the deductible.
It is suggested that you print out the Preferred Drug List (PDL) from the website and take it to any appointments with your physician, so you can talk about your options. The PDL is updated quarterly, so please check for updates throughout the year. Regardless of which plan you elect, your out-of-pocket costs will be lower if you use generic and/or preferred brand name drugs. The PDL is available at either: www.kdheks.gov/hcf/sehp/Caremark.htm or www2.caremark.com/kse. You can also call Caremark at 800-294-6324 for help finding a preferred drug. A number of popular name brand drugs are projected to be available in generic versions during 2014. This list is also on the website.
The Caremark plan is designed to encourage you and your health care provider to choose the most cost-effective and clinically-effective medications available. Home delivery is available through Caremark and reorders are processed in as little as five to seven days. To place an initial order or reorder by phone, call 1-800-294-6324 or e-mail firstname.lastname@example.org
Specialty and biotech drugs are designed for difficult conditions that don’t respond to traditional therapy. These drugs are available only through the Caremark Connect Specialty Pharmacy. Contact Caremark Connect at 1-800-237-2767. A Caremark representative will coordinate patient care with the provider and arrange for medication delivery.