Pharmacy

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The pharmacy program is an integral part of our medical plan offerings.  Our pharmacy program provides you with informational tools available through our administrator, CVS/Caremark, to research the most cost-effective medication available for your condition, and gives you the option of a lower co payment for using a generic medication if available.

OneBeacon provides one pharmacy option regardless of which medical plan you enroll in.  The pharmacy program provides different levels of coverage based on the "tier" of medication that you are receiving.

There are three tiers of coverage:

• Generics
• Formulary Brand
• Non Formulary Brand

The formulary listing is developed by CVS/Caremark.  Each quarter the complete formulary listing is available on this website and also available on the CVS/Caremark website.

The pharmacy program offers you the option of receiving your prescriptions at the pharmacy (any pharmacy in the CVS/Caremark network - not just CVS pharmacies), or if you are on a maintenance medication (one which you take regularly), you can receive a 90 day supply of your prescriptions using the home delivery program and save money!  CVS/Caremark also allows employees the choice to pick up their 90 day supply of maintenance medications at CVS pharmacies.

There are also certain situations where the pharmacy program requires you to take specific actions to obtain the same benefit level.  These apply to individuals receiving maintenance medications or requiring specialty injectables.  CVS/Caremark will provide personalized reminder notices to participants impacted by these programs.

Following are the details regarding these programs:

Caremark Mail Service Pharmacy

The CVS/Caremark Home Delivery program pertains to maintenance medications, which are prescription drugs for ongoing conditions.  When you use Home Delivery, you will save money on your co payments.  Plus, you'll receive:

• Free home delivery of your medication
• Up to a 3-month supply of medication with each order
• 24-hour access to a pharmacist
• CVS/Caremark also allows employees the choice to pick up their 90 day supply of maintenance medications at CVS pharmacies

To encourage home-delivery purchases, an additional charge will be applied to 30 day fills of maintenance prescriptions purchased at a retail outlet.  If after the third fill you continue to purchase your maintenance prescription at a retail outlet, an additional charge will be added to the co pay amount as follows:

Generic drugs = Co pay + $8 ($8.00 + $8 = $16.00)
Formulary brand = 30% Co insurance min $60 / max $120
Non formulary brand = 50% Co insurance min $100 / max $200

Prior Authorization (PA) Options Program

The PA Options program, also referred to as Step Therapy Program, is designed for people who are diagnosed with certain conditions, such as arthritis or high blood pressure, which require them to take medications regularly.  This program is developed under the guidance and direction of independent doctors, pharmacists and other medical experts at CVS/Caremark.  Together with CVS/Caremark, this professional panel reviews the most current research on thousands of drugs that have been clinically tested and approved by the FDA for safety and effectiveness.

The PA Options program is designed to work with your physician to encourage the use of the most effective medication for your money.  That means getting a tried and true medication that's proven safe and effective for your condition, and getting it at the lowest possible cost.  With this program, drugs are put into groups based on the co payment amount:

• Front-line drugs - generic drugs proven to be safe, effective and affordable.  These drugs should be tried first because they can provide the same health benefits as more expensive drugs, at a lower cost.
• Back-up drugs - brand-name drugs like those that you see advertised on TV.  There are lower-cost brand drugs and higher-cost brand drugs. Back-up drugs always cost more than front-line drugs.

When you are prescribed a medication, you will be asked to try the front-line drugs first, to see if these cost-effective drugs could work for you.

Specialty Medications

There is one additional, very specific category of medications - specialty medications.  These medications include injectables and oral or inhaled drugs used to treat chronic diseases which may cost hundreds or even thousands of dollars.  You must purchase these medications, through the CVS/Caremark Specialty Pharmacy. 

One additional note regarding the OneBeacon pharmacy program:

Medications that have over-the counter (OTC) equivalents such as ibuprofen and hydrocortisone creams, as well as non-sedating antihistamines, are not covered by the OneBeacon pharmacy plan.