Prescription Drug Coverage
All IU-sponsored medical plans include prescription drug coverage through CVS Caremark. You can use Caremark.com or the Caremark app to create a CVS Caremark account, which will allow you to:
- Locate a participating pharmacy
- Check drug prices and generic alternatives
- View the drug formulary and preventive drug list
- Request mail order refills quickly and conveniently
- View prescription history
- Check drug interactions
- Contact a pharmacist
The CVS Caremark pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket pharmacy chains. Some independent pharmacies are included as well. However, Walgreens pharmacy is NOT in-network.
Resources
Plan Basics
2023 Cost Shares
Review the copay/coinsurance amounts for each plan below. Create an account at Caremark.com to view personalized drug prices based on your plan’s copay/coinsurance structure and your remaining deductible.
IU medical plans feature the Caremark Cost Saver Program, providing members with automatic access to GoodRx pricing on select generic medications. No signup needed—just show your Anthem ID card at any network pharmacy. The program will compare the standard price with the GoodRx price and charge the lower amount, which also counts towards your deductible and out-of-pocket maximum.
Anthem PPO HDHP
Retail (up to 90-day supply)
- In-Network: member pays 20% after deductible
- Out-of-Network: Submit Claim Form and receipt to CVS Caremark for partial reimbursement. Claim counts towards in-network deductible and out-of-pocket max.
Mail Order (up to 90-day supply)
- In-Network: member pays 20% after deductible.
- Out-of-Network: Not covered.
Specialty available only through CVS Specialty pharmacy mail order (up to 30-day supply)
- In-Network: member pays 20% after deductible.
- Out-of-Network: Not covered.
Preventive medications on the No Cost Share Medication List are covered by the plan 100%.
Medications on the HDHP Preventive Rx List are covered with a 20% coinsurance and no deductible.
All prescription cost shares apply toward the HDHP medical out-of-pocket maximum.
Anthem PPO $500 Plan
For a brand drug with a generic version, members must pay the generic copay plus the cost difference between the brand and generic.
In-Network:
Retail (up to 30-day supply)
- $8 generic (Tier 1)
- $25 preferred brands (Tier 2)
- $45 non-preferred brands (Tier 3)
- Non-Covered Drugs (with network discount) – Member pays 100%
Retail or Mail Order (31 to 90-day supply)
- $20 generic (Tier 1)
- $62 preferred brands (Tier 2)
- $112 non-preferred brands (Tier 3)
- Non-Covered Drugs (with network discount) – Member pays 100%
Out-of-Network:
Retail: 50% coinsurance (plus amounts above the network’s discounted price )
Mail Order: Not Covered
Specialty:
Only available through CVS Specialty pharmacy mail order (up to 30-day supply)
- $20 generic (Tier 1)
- $62 preferred brands (Tier 2)
- $112 non-preferred brands (Tier 3)
Preventive medications on the No Cost Share Medication List are covered by the plan 100%.
In-network prescriptions have a separate out-of-pocket maximum from the medical plan: $7,050 per member/$11,700 per family.
Student Academic Appointee (SAA) Plan
In-Network:
Retail (up to 30-day supply)
- $10 generic
- $40 preferred brands
- $75 non-preferred brands
Retail or Mail Order (31 to 90-day supply)
- $20 generic
- $80 preferred brands
- $150 non-preferred brands
Out-of-Network:
Retail: 50% coinsurance (plus amounts above the network’s discounted price )
Mail Order: Not Covered
Specialty (up to 30-day supply):
Only available through CVS Specialty pharmacy mail order.
- $150 copay
Preventive medications on the No Cost Share Medication List are covered by the plan 100%.
In-network prescriptions have a separate out-of-pocket maximum from the medical plan: $6,950 per member/$13,900 per family.
IU Residents Plan
In-Network:
Retail (up to 30-day supply)
- $10 generic
- $25 preferred brands
- $75 non-preferred brands
Retail or Mail Order (31 to 90-day supply)
- $25 generic
- $60 preferred brands
- $180 non-preferred brands
Out-of-Network:
- Retail: 50% coinsurance (plus amounts above the network’s discounted price
- Mail Order: Not Covered
Specialty:
Only available through CVS Specialty pharmacy mail order (up to 30-day supply)
- $150 copay
Preventive medications on the No Cost Share Medication List are covered by the plan 100%.
In-network prescriptions have a separate out-of-pocket maximum from the medical plan: $7,650 per member/$13,500 per family.
Refills and New Orders
Any prescriptions that you have can be filled at a retail pharmacy for a 30-day supply or for a 90-day supply, or through mail order for a 90-day supply.
Be sure to provide your retail pharmacy with your prescription ID card information so that they can process the claim through CVS Caremark. If you use mail order, you will need to create an account at Caremark.com or use the Caremark app to set up your shipping preferences and billing information.
Mail Order and 90-day Supply at Retail Locations
You will save money when you get a 90-day supply of your medications. You will make fewer trips to the pharmacy, and you’ll only need to make one payment every three months.
Mail order is another option for those that would like to get a 90-day supply of medications shipped to their home.
You can do this through your account on the CVS Caremark website, by calling CVS Caremark, or using the Caremark app and scanning the bar codes or QR codes on your mail service prescriptions to request your refills.
Specialty Medications
Specialty medications are drugs that are used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis. CVS Caremark has a separate arrangement for specialty medications to be provided through CVS Specialty. CVS Specialty must be used to fill specialty drug prescription orders, subject to a 30-day supply with the applicable coinsurance or copayment.
You will need to get a new prescription if your current prescription has expired or if there are no refills left. For new specialty prescriptions you can ask your doctor to e-prescribe by calling 800-237-2767 or fax to 800-323-2445.
Medications with No Cost Share
IU-sponsored medical plans cover 100 percent of the cost of certain medications as defined by the Affordable Care Act (ACA). This includes tobacco cessation prescriptions and over-the-counter tobacco replacement products. Coverage is limited to a 180-day supply per covered individual per year. Over-the-counter products require a prescription to be covered. For a full list, along with criteria for coverage, see the CVS Caremark No-Cost Preventive Drug List.
Frequently Asked Questions
Below are answers to the most frequently asked questions regarding the Prescription program.
Where can I find a network pharmacy?
The CVS Caremark pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket pharmacy chains. Some independent pharmacies are also included. However, Walgreens pharmacy is NOT in-network. Visit the CVS Caremark Pharmacy Locator to find a network pharmacy near you.
Where can I find the cost of my prescriptions?
Create an account at Caremark.com to view personalized drug prices based on your plan’s copay/coinsurance structure and your remaining deductible.
If you are not yet enrolled in a plan you can check drug costs for each plan:
What are preventive prescriptions?
If you're enrolled in the Anthem PPO HDHP (high deductible health plan) you do not need to meet a deductible for preventive prescriptions. Instead, for all medications on the Preventive Drug List you’ll only pay the 20% coinsurance. This no-deductible preventive drug list not only saves you money but is an important step in preventing more serious health issues in the future. Check specific drug costs on Caremark.com.
What options are available for lowering and/or containing my medication costs?
There are several options available:
- Talk with your pharmacist or physician about generic and formulary brand name drug alternatives to determine if a less expensive alternative is available. Generic Drugs are required by law to have the same active ingredients, dosage, form, and strength as their brand-name equivalents, but they generally cost less.
- Talk to your pharmacist/provider about less expensive therapeutic equivalent medications.
- Switch from a 30-day to 90-day supply. This option is especially beneficial for those with chronic conditions who might be taking multiple medications. CVS Caremark has both a mail order option and an option to get a 90-day supply at in-network retail pharmacies.
Customer Service Contacts
CVS Caremark
Member Services: 866-234-6952
www.Caremark.com
CVS Specialty: 800-237-2767
www.CVSspecialty.com
IU Human Resources
Customer Care: 812-856-1234
Email: