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Pharmacy Benefits


80/20 Plan for Non-Medicare Retirees
Pharmacy Benefits

The 80/20 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 that this 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 80/20 Plan Pharmacy benefit includes:

80/20 Plan Pharmacy Copay

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

​$5 $10 $15
Tier 2
$30 ​$60 ​$90
Tier 3
20% coinsurance after deductible 20% coinsurance after deductible 20% coinsurance after deductible
Tier 4​ $100 $200 $300
​Tier 5 $250 $500 $750​
​Tier 6 ​20% coinsurance after deductible ​20% coinsurance after deductible
​20% coinsurance after deductible
 

Diabetic Supplies Copay

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

​$5 $10 $15
Non-preferred Brand
​20% coinsurance after deductible ​20% coinsurance after deductible ​20% coinsurance after deductible
 

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

 

Prescription drug copayments are limited to $2,500 per person per benefit period. After the $2,500 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

2018 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, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”

 

 
 

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​​​.