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 2024 NALC Health Benefit Plan brochure (RI 71-009) for complete details.

Your 2024 Drug Cost-Share When NALC is Primary Carrier

*Generic Drug:**		You Pay:
Network Retail	up to 30 day supply	20% of Cost (10% of cost for asthma, diabetes & hypertension)
Mail Order	up to 60 day supply	$10
Mail Order	61 - 90 day supply	$15 ($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	$60
Mail Order	61 - 90 day supply	$90 ($50 Formulary brand for asthma, diabetes & hypertension)

Non-Formulary Brand Drug:		You Pay:
Network Retail	up to 30 day supply	50% of Cost
Mail Order	up to 60 day supply	$84
Mail Order	61 - 90 day supply	$125 ($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	$200
Mail Order	31 - 60 day supply	$300
Mail Order	61 - 90 day supply	$400

Your 2024 Drug Cost-Share When Medicare Part B is Primary

*Generic Drug:**		You Pay:
Network Retail	up to 30 day supply	10% of Cost (5% of cost for asthma, diabetes & hypertension)
Mail Order	up to 60 day supply	$7
Mail Order	61 - 90 day supply	$10 ($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	$50
Mail Order	61 - 90 day supply	$75 ($40 Formulary brand for asthma, diabetes & hypertension)
Non-Formulary Brand Drug:		You Pay:
Network Retail	up to 30 day supply	40% of Cost
Mail Order	up to 60 day supply	$75
Mail Order	61 - 90 day supply	$110 ($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	$200
Mail Order	31 - 60 day supply	$300
Mail Order	61 - 90 day supply	$400

Specialty Drugs

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

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.

All specialty drugs require preauthorization and may include step therapy; call CVS Specialty^TM at 800-237-2767. Our benefit includes the Advanced Control Specialty formulary that includes a step therapy program and uses evidence-based protocols that require the use of the preferred drug(s) before non-preferred specialty drugs are covered. The Advanced Control Specialty Formulary is designed as a specialty drug formulary that includes generics and clinically effective brands as determined trough clinical evidence. The therapy classes chosen for Advanced Control Specialty Formulary have mutliple specialty drugs available that are considred therapeutically equivalent (similar safety and efficacy), thus providing the opportunity to utilize the lowest cost drug(s). In addition, categories, therapies and tiering changes could be updated every quarter and added to the formulary. Please refer to the Advanced Control Specialty formulary drug list for more information about the drugs and classes.
All specialty drugs must be purchased through the CVS Specialty^TM.
The Specialty Connect feature allows you to submit your specialty medication prescription to your local CVS pharmacy. See Section 5(h). Wellness and Other Special features of our brochure or call 800-237-2767 for more information.

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.

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. 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. You pay $10 generic and $60 brand name for up to a 60-day supply. You pay $15 for other generics and $90 formulary brand name for up to a 90-day supply.

When Medicare Part B is your primary payor, you pay $7 generic and $50 brand name for a 60-day supply. You pay $10 for other generics and $75 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.