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Medicare Advantage Plan Prescription Coverage

Participants in Carnegie Mellon's Medicare Advantage plans have prescription coverage through their medical plan. For a list of preferred and in-network pharmacies, contact your carrier's customer service. See the plan summaries for details on prescription drug copay and coinsurance.

Two ways to (re)fill a prescription at a participating pharmacy:

• Present your member card along with your prescription. You'll pay the designated copay, based on the drug's generic or formulary status.
• Pay for the medication in full and request reimbursement from the carrier.

Caremark: For Major Medical/Supplemental Drug Plan

Caremark is the supplemental prescription administrator for our Major Medical coverage. It must be paired with a primary Medicare Part D plan. Once the $250 deductible is met, the Caremark Supplemental Prescription Drug coverage pays 80% coinsurance of the remaining cost of generic and preferred medications. If a medication is non-preferred, it will not be covered by the Caremark secondary coverage.

Two ways to (re)fill a prescription at a participating pharmacy:

• Present your ID card at the pharmacy, and your claim will be processed under the plan at the point of service.
• Pay for the drug in full and then submit a  to Caremark along with your receipts and explanation of benefits.

Generic and Formulary Drugs: Managing Drug Costs

Generic Drugs

The Medicare Advantage plans require that generic drugs be substituted automatically when available, unless a medical necessity waiver has been submitted by your physician and approved in advance. Using a brand-name drug when a generic substitution can be made will result in additional costs to you.

Formulary

Our retiree plans and most Medicare Advantage and Part D plans use a formulary (a list of preferred medications). Consider trying a formulary medication to maximize your cost savings.

• See your carrier website for a current list of the drugs on its formulary.
• Bring the formulary list to your doctor's office to ensure a formulary medication has been selected before having the prescription filled.

Mail Order Prescriptions: Convenience and Affordability

When you get long-term use or maintenance medications through mail order, you only need to order refills every few months, instead of going to the pharmacy every few weeks. You generally save money with lower copays or coinsurance.

• CMU Retiree Medicare Advantage plans provide mail order services for medications prescribed more than two months. Forms and instructions can be found on the carriers' websites.
• Caremark will reimburse you for 80% of your mail order medication costs (after the $250 deductible is met).
  • Send the prescription and payment to your Part D carrier's mail order service.
  • Send a copy of the receipt and the completed to Caremark.

Writing Prescriptions for Mail Order

• Your doctor should write the prescription for a 90-day supply (not 30-day) with the appropriate number of refills.
• New prescriptions take up to two weeks to fill. (Refills generally take less time.) If you need the drug immediately, ask for samples or a script for a short-term supply that can be filled at your pharmacy.