2015 Prescription Drug Benefit Summary
Below is a summary of prescription drug benefits for The University of Akron effective January 1, 2015.
This document is not a complete summary of all of the terms of this benefit coverage. This coverage is a
component of The University of Akron’s medical benefit coverage program. Details regarding other
benefit plan provisions such as eligibility and other important provisions can be found on the Benefits
Website. Should you have additional questions about the prescription drug benefit, please start by
visiting CVSCareMark’s Website or call their Customer Service department toll free at 888-202-1654.
CO-PAYMENTS
Generic
Prescription Drugs
(Tier 1)
Preferred Brand
Prescription Drugs
(Tier 2)
Non-Preferred
Brand Prescription
Drugs
(Tier 3)
Specialty
Prescription Drugs
(Tier 4)
Out of Pocket
Maximums for
Active Employee
Plans
PPO Gold 90
& Retiree Dependent PPO
& Retiree Dependent Medicare
Supplement Plan
PPO Blue 80
Retail *
Mail Order **
Retail *
Mail Order **
(30 Day Supply)
(90 Day Supply)
(30 Day Supply)
(90 Day Supply)
$10
$25
$12
$30
20% ($50 Max)
20% ($125 Max)
25% ($60 Max)
25% ($150 Max)
25% ($70 Max)
25% ($175 Max)
35% ($100 Max)
35% ($250 Max)
25% ($125 Max)
--
35% ($150 Max)
--
$3,600 Individual
$2,100 Individual
$7,200 Family
$4,200 Family
* For a complete list of the participating pharmacies, please visit www.caremark.com or call us toll free at 888202-1654.
** Not all drugs are available through mail order. Please call to determine if the drug(s) you take can be filled
for a 90 day supply.
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RETAIL PRESCRIPTIONS
To receive a prescription at a retail pharmacy you must go to a network pharmacy and present your
prescription card. If you need to purchase a prescription at a non-participating pharmacy you will be
required to submit a direct member reimbursement form. This form can be obtained on the website or
by calling the Customer Service department toll free at 1-888-202-1654.
LOST IDENTIFICATION CARD
Your prescription card is sent from CVSCareMark. Should you need your to obtain prescriptions
immediately, please contacts Benefits Administration at 330-972-7090 for assistance.
UTILIZATION MANAGEMENT PROGRAMS
CVSCareMark and The University of Akron work together to find ways to provide better prescription
coverage while managing the rising costs of prescription medications. The Plan uses tools such as copayments, Step Therapy, Prior Authorization, and Quantity Limits to achieve these goals. These
programs are designed to maximize value. The goal is to help you choose a medication that’s proven
safe and effective for your condition, while getting it at the lowest possible cost. By using the most costeffective first line medications you will not only save money with lower co-payments, but the plan saves
as well; helping to ensure that The University of Akron can continue to provide excellent prescription
coverage for you and your family.
MANDATORY GENERIC MEDICATIONS
A generic drug is identical to a brand name drug in that it is required to have the same active
ingredient(s), strength, dosage, way it works, way it is taken, and the way it should be used. When a
generic drug product is approved, it has met rigorous standards established by the Food and Drug
Administration (FDA). There is little difference between a brand-name drug and its generic equivalent.
The generic may differ from the brand-name drug in color, shape, size, or taste, but these things don’t
affect the way the drug works and they are looked at by the FDA. The big difference is that generics
usually cost less than the brand. You are encouraged to work with your doctor to use generics, when
they are right for you.
If the member or the physician wishes to use a brand name drug when the FDA has approved a
therapeutically equivalent generic, the member will pay the difference in the brand name and generic
medication price, plus the generic co-payment. There are no exceptions for this mandatory generic
provision.
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STEP THERAPY PROGRAM
A step therapy program is designed specifically for patients with certain conditions that require them to
take medications regularly. It is the practice of beginning medication therapy for a medical condition
with the most cost-effective drug and progressing to other more costly therapy(s) should the initial
medication not provide adequate therapeutic benefit. You will first try a recognized First Line
medication (Step 1) before approval of a more costly and complex therapy is approved (Step 2). If the
Step 1 therapy does not provide you with the therapeutic benefit desired, your physician may write a
prescription for a Second Line medication. Generally, Second Line medications require the usage and
failure of a First Line medication before coverage will be approved. The step therapy approach to care is
a way to provide you with savings without compromising your quality of care.
Step Therapy Medication List
Classification
Generic Medication Name
Bisphos-phonates
alendronate, ibandronate , risedronate
COX2 inhibitors/ Non -Steroidal AntiInflammatory Drugs (NSAIDs)
diclofenac potassium, diclofenac sodium,
diflunisal, etodolac, genoprofen, flurbiprofen,
ibuprofen, ketoprofen, meclofenamate,
mefenamic Acid, meloxicam, nabumetone,
naproxen, naproxen Sodium, oxaprozin,
piroxicam, salsalate, sulindac, tolmetin
HMG-CoA Reductase Inhibitors
lovastatin, pravastatin, simvastatin, atorvastatin,
fluvastatin, amlodipine atorvastatin
Sleep Agents
eszopiclone, zaleplon, zolpidem, zolpidem ext-rel
CVSCareMark’s Therapeutics Committee is responsible for the development and maintenance of the
Step Therapy List. Because new drugs are constantly being introduced to the market, please check with
CVSCareMark for the most up-to-date information.
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DRUGS REQUIRING PRIOR AUTHORIZATION
Some medications will require a prior authorization, which is clarification by your prescribing physician
for a certain medication. Please refer to the chart below for a list of drug classifications that will require
a prior authorization. If you have questions about the medications that require a prior authorization,
call the CVSCareMark. They will fax a medical necessity form to your physician and CVSCareMark
Clinical Staff will determine if the medication will be approved for your medical condition.
Non Specialty Prior Authorization List (Alphabetically)
Acne (after age 35)
ADHD/Narcolepsy (after age 19)
Compound Medications (over $300)
Pain, Oral/Intranasal Fentanyl Products (oral/intranasal narcotics)
Pain, Topical
Retinoids (topical)
suboxone, subutex , zubsolv
QUANTITY LIMITS
Quantity limits are used to manage the quantity of medications available to any member that may be
potentially harmful, subject to abuse, is not consistent with the standard of care in today’s medical
practice, or other reasons. Certain lifestyle medications (such as Viagra, Cialis) are subject to quantity
limits or other medications that could potentially be harmful if certain dosages are exceeded. Members
may obtain prior authorization to receive such medications at the higher than normal dosage when
medically necessary. The chart below lists medications subject to quantity limits. CVSCareMark is
responsible for the development and maintenance of the Quantity Limit List. Because new drugs are
constantly being introduced to the market, please check with CVSCareMark for the most up-to-date
information.
Quantity Limit List (Alphabetically)
Anticholinergic, Combination, Mast Cell Stabilizer Oral Inhalation (misc. asthma / COPD
agents)
AntiMigraine
Antiemetic (Anti-nausea)
Beta2-Adrenertic Agonist, Combination Oral Inhalation (respiratory / asthma inhalers)
Corticosteroid Oral Inhalation (steroid inhalers)
ED Alprostadils, PDE-5 Inhibitors Limit & ED-BPH Cialis 5mg Post Limit
Influenza
Pain - APAP and ASA containing narcotics, oxycontin
Proton Pump Inhibitors (PPIs) (stomach acid relief)
Sedative/ Hypnotics (insomnia drugs)
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