Each January, for the past several years, some members have felt surprise and confusion at the amount they are charged for medications. Although at first glance this appears to be a change in price, it’s actually just the annual prescription deductible, which goes into effect each January. This deductible applies to prescription medication for all Chicago Public Schools employees enrolled in the Blue Cross Blue Shield Blue Advantage HMO or PPO plan. You will need to pay a $75 prescription drug deductible per the calendar year per household. Employees enrolled in the HSA plan must satisfy the medical deductible before prescription coinsurance applies.
When you first attempt to fill a prescription, you will pay $75 before any medications are covered. Once you pay $75, your co-pays kick in. Your co-pays will be $10 for generics, $40 for brand names on the drug list (or $55 for brand names not on the drug list) and $95 for specialty medicines. You can attain lower prices by using the 90-day mail order. The mail order must go through CVS Caremark. Some CVS pharmacies will allow you to purchase a three-month supply on site.
There are requirements for “maintenance medication.” When starting with your sixth refill and subsequent fills, you will be required to pay 40 percent of the drug cost or the co-pay. You can avoid this penalty by obtaining a 90-day prescription or using mail service. Each 90-day supply should only count as one refill, allowing you to avoid any additional expenses. If it is a controlled substance, you are not required to pay the penalty.
While the RX deductible is frustrating, Caremark assured us that the program leads to greater savings to members. Prescription deductibles are very common tools used to help reduce overall costs for health care. The key ways to reduce your costs are by using generics and using the 90-day prescription program when appropriate.
To take advantage of these savings, ask your doctor to write a 90-day prescription for your long-term medications to be filled at CVS or Target. Another option is to go through Caremark’s bulk generic mail program. You can do this by asking your doctor to call the fast-start department at Caremark at (800) 378-5697. You can also get a 90-day supply directly at the CVS location at 69 W. Washington Street.
If you cannot use a generic drug, your physician can fill out a form or verbally appeal directly to Caremark. Caremark’s customer care team is available to help you and your family with any questions. They are available 24/7, 365 days a year at 866-409-8523.