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About Your Benefits

"LET'S TALK PREVENTION" is a valuable resource outlining all of the various benefits available to members through Caremark at NO COST TO YOU! These benefits are part of the Affordable Care Act (ACA) and are provided through your SEHP medical plan.

Prescription drug coverage through Caremark is included with Plans A, C, J, and N. 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: Prescription drugs are not subject to the medical Deductible Under this plan, generally you pay a Coinsurance for your prescription drug costs throughout the year, up to a combined medical and pharmacy Out Of Pocket maximum of $6,250 for single and $12,500 for member with dependent coverage per year. Click here to check drug cost for Plan A. The amount shown is your estimated cost for the specific medication.

Plans C, J, and N: Prescription drugs are subject to the Deductible so until you reach your Deductible, when you present your Caremark ID card, you will pay 100% of the discounted cost for your prescription drugs. Once you have reached the Deductible, you pay a Coinsurance for your prescription drug costs throughout the year, up to the combined medical and pharmacy Out Of Pocket (OOP) maximum. See your plan document for the OOP maximums for your plan. Click here to check drug cost for Plans C, J, and N. Search results will give you the estimated plan allowance for the specific medication, then you will need to apply the applicable prescription benefits.

Note: When using the drug cost links, it is recommended the search be performed using a 30-day supply of your medication. If you are already an active SEHP participant, you should log on to Caremark.com and perform your search. The Caremark.com site will provide you with a cost estimate based upon your actual health plan enrollment.

Before your next medical appointment, it is suggested that you print out the Preferred Drug List (PDL) from the website and take it with you so you can discuss your prescription drug options with your health care provider. The Caremark plan is designed to encourage you and your health care provider to choose the most cost-effective and clinically-effective medications available. The PDL is available in the Plan documents below or www.caremark.com. You can also call Caremark at 800-294-6324 for help finding a preferred drug.

Home Delivery

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 email online@caremark.com. You may access the Mail Order Service Profile form here.

Specialty and Biotech Drugs

Specialty and biotech drugs are designed for difficult conditions that don’t respond to traditional therapy. A complete list of Specialty Drugs is available in the plan documents below or at www.Caremark.com. 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.

Regardless of which plan you elect, your Out Of Pocket costs will be lower if you use generic and/or preferred brand name drugs. For additional assistance on ways to lower your prescription drug costs, see the Rx Savings Solutions website or call them at: 1.800.268.4476.

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