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Mailing Address:
U.Va. Human Resources
914 Emmet Street
P.O. Box 400127
Charlottesville, VA
22904
Phone: 434.982.0123
Email: hrdept@virginia.edu
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| Benefits Summary for University Staff |
Effective January 1, 2009
Prescription Drug Program
The Outpatient Prescription Drug program is administered by CVS Caremark, www.caremark.com and covers certain medically necessary prescription drugs dispensed by licensed pharmacies with mandatory generic substitution. For enrollees with diabetes, the program also covers insulin, glucose meters, syringes, and lancets. For all prescriptions, if a generic drug is available, only the allowance for the generic is covered. If the physician prescribes a brand name drug, you must pay the brand copayment as well as the difference between the price of the generic and the cost of the brand name drug, which can potentially be a significant member expense, unless brand is approved by medical necessity appeal with CVS Caremark.
CVS Caremark Specialty Pharmacy provides injectable and/or biotechnology medications for participants with complex medical issues. UVa Health Plan members will be required to obtain all specialty and injectable medications through CVS Caremark Specialty Pharmacy. ( Note: the initial fill of a specialty prescription may be obtained from local retail participating Pharmacy if available). This means that the UVA Health Plan participants can not purchase specialty drugs directly from their physician, and charges for these drugs cannot be billed as medical claims.
Copayments for a 30-day supply are available in 3 tiers: $6 for generic drugs, $24 for formulary brand name drugs when no generic is available, and $48 for non-formulary brand name drugs when no generic is available. Mail order service through CVS Caremark is available for drugs up to a 90-day supply at the following 3 tier copayments: generic at $14, Formulary (preferred) brand at $56 when no generic is available, and Non-Formulary (non-preferred) brand at $112, when no generic is available.
Note about generic medications:
After checking costs for their medications, a UVA Health Plan member may decide to refrain from using the UVa Health Plan Prescription Drug card and, instead, purchase generic drugs at retail pharmacies that offer lower copayments for selected generic drugs.
Members can order prescriptions through the CVS Caremark mail order by mailing your original prescription along with the mail service order form to Caremark.
Here is a link to the CVS Caremark mail service order form .
Prescriptions for a 31-90 day supply are also available at retail pharmacies. The UVa Health Plan does not offer discounted copayments for 31-90 day prescriptions filled at retail pharmacies.
Please note that there are increased costs when a generic is available and a member uses a brand name: Whether using the retail pharmacy or mail-order, when a generic is available, your cost-sharing amount is significantly higher since you must pay the brand copayment as well as the difference between the price of the generic and the cost of the brand name drug, unless brand is approved by medical necessity appeal with CVS Caremark.
The Formulary List identifies drugs that are considered preferred or formulary. It is not an all inclusive list. The Formulary List is subject to change and is usually updated every 3 months. Drugs needing prior authorization, requiring Contingent Therapy Protocol/Step Therapy or having Quantity Limits are included at the end of the Formulary List.
Specialty medications copayments are available at $25 (generic), $50 Formulary (preferred brand), and $75 for non formulary (non-preferred) brands.
If you want to calculate copays for a specific medication, you may use the CVS Caremark check drug price option located at http://www2.caremark.com/uva/. This website has other UVa -specific prescription drug plan information that may be informative to members.
Drugs needing prior authorization, requiring Contingent Therapy Protocol (CTP) or having quantity limits are included at the end of the Formulary List.
The Prescription Drug Plan also has a discount price benefit program for a number of prescription drugs that are not available through the UVA Health Plan. With the discount benefit, when you use your prescription drug card to purchase these drugs, you will pay the discounted price negotiated by UVa’s Pharmacy Benefit Manager instead of the full retail price. Although you will still pay 100% of the cost rather than a copayment, the cost will be less than the retail cost in most cases. They include prescription non-sedating antihistamines, vitamins and diet pills, infertility medication, and drugs not considered medically necessary, such as cosmetic drugs. Experimental or investigational drugs and other standard exclusions will not be included in the discount price benefit program.
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