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Pharmacy Benefits


70/30 Plan for Active Employees
Pharmacy Benefits

The 70/30 Plan includes pharmacy benefits. When visiting a participating pharmacy, be sure to present your State Health Plan ID card.

The State Health Plan utilizes a Pharmacy Benefit Manager (PBM), which administers the pharmacy benefit. The current PBM for the State Health Plan is CVS Caremark. Members should also note that this change does NOT mean members will have to go to a CVS pharmacy location for their prescriptions. CVS Caremark has a broad pharmacy network, which can be found using the Pharmacy Locator Tool.

Detailed information regarding your benefits is available below and is also available in your benefits booklet.

The 70/30 prescription benefits cover:

  • Federal legend prescription drugs

  • Self-administered injectable medications

  • Insulin

  • Diabetic testing supplies

  • Certain immunizations

  • 2017 Comprehensive Formulary

70/30 Plan Pharmacy Copays

Tier Up to 30-day Supply 31-60 day Supply 61-90 day Supply​
Tier 1

​$16 $32 $48
Tier 2
$47 ​$94 ​$141
Tier 3
​$74 ​ $148 $222
Tier 4​ ​10% coinsurance up to $100 for each 30 day supply 10% coinsurance up to $200 for each 60 day supply ​10% coinsurance up to $300 for each 90-day supply
​Tier 5 ​25% coinsurance up to $103 for each 30-day supply ​25% coinsurance up to $206 for each 60-day supply 25% coinsurance up to $309 for each 90-day supply​
​Tier 6 25% coinsurance up to $133 for each 30-day supply​ 25% coinsurance up to $266 for each 60-day supply​ 25% coinsurance up to $399 for each 90-day supply​


Diabetic Supplies Copay

Brand Up to 30-day Supply 31-60 day Supply 61-90 day Supply​
Preferred Brand

​$10 $20 $30​
Non-preferred Brand
$74 ​$148 ​$222


Additional test strips are covered under your medical benefit and are subject to deductible and coinsurance.

Prescription drug copayments are limited to $3,360 per person per benefit period. After the $3,360 maximum is reached, the State Health Plan pays 100 percent of allowed prescription drug charges per benefit period.

For questions regarding your Pharmacy benefit, please call CVS Caremark Customer Service at 888-321-3124, or visit Caremark.com.

Formulary Exclusion Exception Process

Formulary Exclusion Exception Process
Formulary Exclusion Exception Provider Form

2017 Drug Cost Lookup and Pharmacy Locator Tools

Click below to access the Drug Cost Lookup and Pharmacy Locator Tools.

Please note: If a drug will not be covered by the State Health Plan effective January 1, 2017, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”

Traditional 70/30 Plan Drug Cost Lookup Tool
 
2017 Pharmacy Locator Tool 

Notice of Creditable Coverage

​The Notice of Creditable Coverage verifies that the State Health Plan provides prescription drug coverage that is expected to pay at least as much as the standard Medicare Part D prescription drug coverage under Centers for Medicare and Medicaid Services (CMS) regulations. The notice is available by clicking here​​​.