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Mailing Address:
U.Va. Human Resources
914 Emmet Street
P.O. Box 400127
Charlottesville, VA
22904
Phone: (434) 924-4598
Email: hrdept@virginia.edu
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| Benefits Summary for Classified Staff & Research Assistant/Associates |
Effective January 1, 2008
Prescription Drug Program
The Outpatient Prescription Drug program is administered by CVS Caremark, formerly known as PharmaCare, (http://www.pharmacare.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.
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 or through a participating retail 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: $9 for formulary generic drugs, $22 for formulary brand name drugs when no generic is available, and $44 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 $21, Formulary (preferred) brand at $52 when no generic is available, and Non-Formulary (non-preferred) brand at $103 when no generic is available. (Note about generic medications: a UVA Health Plan member may decide after checking costs for their medication to not use the Prescription Drug card and purchase a $4 generic at retail pharmacy ) Those employees using the CVS Caremark website for the first time to refill mail order prescriptions should call CVS Caremark at 1-800-581-5300 after enrolling on-line to ensure you are properly registered. 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.
Note about increased costs when generic is available :: Whether using the retail pharmacy or mail-order, when a generic is available, your cost-sharing amount is 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.
The Formulary List identifies all drugs that are considered non-formulary. Any brand name drug not included on this non-formulary list is a formulary drug.
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 copay counselor located at http://www.pharmacare.com/members/virginia/
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 non-sedating antihistamines, vitamins and diet pills, nicotine gum, infertility medication, travel-related drugs 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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