Prescription Benefit

Change to CVS Caremark

Your Fund has changed pharmacy benefit managers from Express Scripts to CVS Caremark effective July 1, 2024. Visit the 1199SEIU CVS Caremark member portal at Caremark.com/StartNow.

Select Your Plan

Plan A: Member Choice Home Care Select Plan

If you select Plan A, our Member Choice Home Care Select plan, you have no co-payments for covered medications or medical services when you use your pre-selected Health Center for primary care.

Plan B: Panel Provider Plan

If you select Plan B, our Panel Provider plan, you receive the same quality care – with minimal co-pays for certain services (see below) – by choosing participating providers within the Home Care Benefit Fund network.

Using Your Plan

The Preferred Drug List (PDL)

Have your doctor prescribe preferred drugs on the 1199SEIU Preferred Drug List (PDL). Share this list with your doctor and work together to find the best covered option for you. If your doctor prescribes a drug in a category covered by the Benefit Fund but you don’t see it on the Preferred Drug List, just ask your doctor to prescribe any generic medication or a brand-name if there are no generics available.

The 90-Day Rx Solution

Fill long-term medications through The 90-Day Rx Solution, the Benefit Fund’s maintenance drug program. Ask your doctor to write your prescription for a three-month supply with three refills (a year’s supply in total), and fill it through CVS Specialty, or order and pick up your prescription at any CVS, Rite Aid, Walgreens or Duane Reade pharmacy nationwide.

Participating Pharmacies

Fill short-term prescriptions at participating pharmacies.

Prior Authorization

Some medications and services require prior authorization. If your doctor thinks you need a medication that is not on the Preferred Drug List, call CVS Caremark at (833) 250-3237 or CVS Specialty at (855) 299-3262.

Specialty, Step Therapy and Quantity Duration Drugs

In order to continue to safeguard your health while providing you access to the medications you need, we use prescription programs such as our specialty medications list and drug quantity management drug list.

Prescription Co-Pays

 

Plan A Plan B Plan A or Plan B
Service Cost with Participating Provider Cost with Non-Participating Provider
Generic Drugs $0 $3 co-pay/retail prescription;
$6 co-pay/mail-order prescription
You may be charged the amount the provider bills above the Fund’s payment.
Preferred Brand Drugs $0 $6 co-pay/retail prescription;
$12 co-pay/mail-order prescription
You may be charged the amount the provider bills above the Fund’s payment.
Non-Preferred Brand Drugs You will be charged a differential. $6 co-pay/retail prescription;
$12 co-pay/mail-order prescription;
You will be charged a differential.
You may be charged the amount the provider bills above the Fund’s preferred drug price.
Specialty Drugs No charge for generic and preferred brands. You will be charged a differential for nonpreferred brand drugs. $6 co-pay/retail prescription;
Generic and brand co-pays apply (see above). You will also be charged a differential for non-preferred brand drugs.
You may be charged the amount the provider bills above the Fund’s preferred drug price.

Your Benefit Overviews

Additional Resources

Reimbursement for Drugs Purchased on or Before June 30, 2024

Use the Express Scripts Direct Claim Reimbursement Form for drugs purchased on or before June 30, 2024. For purchases on or after July 1, 2024, use the related CVS Caremark form above.

Home Care For Your Benefit

Home Care For Your Benefit, your member magazine, is now available to view online.