Prescription benefits overview
Prescription and pharmacy benefits information
Your medicine is important
All MHBP plans include comprehensive prescription drug coverage. And offer tools and guidance to help you find covered medicine and understand your costs.
This means you can get access to nationwide network pharmacies, low copays for generic medications and mail-order pharmacy services. Our prescription drug plans offer tools and guidance to help you find covered medicine and understand your costs.
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Make the best choices for your health and budget no matter which MHBP plan option you have
- Nationwide access to network pharmacies
- Low co-payments for covered generic medications at network pharmacies for up to a 30-day supply
- Benefits for 90-day supply at mail order pharmacy or CVS Retail pharmacy - for lower out-of-pocket costs
- Benefits for your prescriptions when overseas
Mail order pharmacy
Ask your doctor to consider prescribing medications from your Prescription Drug Guide/Formulary drug list when medically appropriate. To help save you money, ask if a generic medication is available.
You may also order your prescriptions by mail, internet or phone.
Prescription benefits
(when Medicare is not primary)
All MHBP plans include comprehensive prescription drug coverage.
Tips for using your prescription benefits:
- Ask your doctor to consider prescribing medications from your Prescription Drug Guide/Formulary drug list when medically appropriate. To help save you money, ask if a generic medication is available.
- Fill your prescriptions at a network pharmacy.
- Renew prescriptions before you run out of your medication, or ask us about our Auto Refill or Renewal Programs.
- Provide your MHBP ID card at the pharmacy.
- *Use Vaccine Network pharmacies to get your flu shot and other covered immunizations — you’ll pay nothing.
Remember: Certain drugs require preauthorization. Current listings of these drugs are available below. Refer to Section 5(f) of the official Plan brochure for more details on your prescription drug coverage.
*Please note: MHBP offers a Vaccine Network Pharmacy Program that covers seasonal and non-season vaccines, please refer to Section 5(f) of the official Plan brochure for more details.
Talk to a nurse anytime
Nurses are available to answer general medication questions at no cost to you anytime at 1-800-556-1555 (TTY: 711). Select the option to speak to a nurse.
Standard Option Rx benefits (No deductible applies)
Generic – You Pay | Preferred Brand** – You Pay | Non-Preferred Brand** – You Pay | Generic/Preferred Brand Specialty Drugs † – You Pay | |
---|---|---|---|---|
Up to 30-day supply from a network pharmacy | $5 copay | 30% of the Plan’s allowance, limited to $200 per prescription | 50% of the Plan’s allowance, limited to $200 per prescription | 15% of the Plan’s allowance, limited to $225 per prescription |
Up to 90-day supply through mail order or CVS Caremark Specialty Pharmacy | $10 copay | $80 copay | $120 copay | 15% of the Plan’s allowance, limited to $425 per prescription |
Consumer Option Rx benefits (Deductible applies)
Generic** – You Pay | Preferred Brand Name (Formulary)** – You Pay | Non-Preferred Brand Name (non-formulary) ** – You Pay | Generic/Preferred Brand Specialty Drugs † – You Pay | |
---|---|---|---|---|
Up to 30-day supply from a network pharmacy | $10 copayment* | 30% of the Plan’s allowance, limited to $200 per prescription* | 50% of the Plan’s allowance, limited to $200 per prescription.* | 30% of the Plan’s allowance, limited to $225 per prescription* |
Up to 90-day supply through mail order or CVS Caremark Specialty Pharmacy | $20 copayment* | $80 copayment per prescription* | $120 copayment per prescription* | 30% of the Plan’s allowance, limited to $425 per prescription* |
Value Plan Rx benefits (No deductible applies)
Generic – You Pay | Preferred Brand* – You Pay | Non-Preferred Brand* – You Pay | |
---|---|---|---|
Up to 30-day supply from a network pharmacy | $10 copay | 45% of the Plan’s allowance, limited to $300 per prescription | 75% of the Plan’s allowance, limited to $500 per prescription |
Up to 90-day supply through mail order | $30 copay | 45% of the Plan’s allowance, limited to $500 per prescription | 75% of the Plan’s allowance, limited to $700 per prescription |
Prescription drug coverage resources
Are generic drugs really as good as brand names?
You might wonder if generic drugs are as good as brand-name ones. You might think that generic drugs are lower in quality and not as effective as brand-name drugs. This is not true. Generic drugs are:
- Safe and effective – The U.S. Food and Drug Administration (FDA) holds generic drugs to the same standard as their brand-name alternative. They must have the same active ingredients, be equivalent in strength and dosage, and meet the same standards for safety, purity and effectiveness as the original brand-name product.
- Cost-effective – You save money when you choose generic drugs over brand-name drugs.
The fact is, generic drugs work just as well as brand-name drugs, but cost less. And generics are available for many brand-name drugs. So when you need a new prescription, ask your doctor if a generic equivalent can be prescribed.
- For help with any of these prescription drug resources, please call CVS Caremark® at 1-866-623-1441 (TTY: 711).
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