Pharmacy Coverage

Pharmacy Coverage is provided to all eligible employees † who enroll in Medical Insurance. Coverage will be effective on the date of hire or the first day of the semester for faculty members.

The State of Rhode Island's pharmacy plan is administered by CVS Caremark. Prescriptions can be filled at any in-network pharmacy. For details regarding pharmacy coverage see the Summary of Coverage or contact CVS Caremark at www.caremark.com or call the customer service number: 1-800-307-5432.

To obtain a 3 month supply of a prescription drug for 2 co-payments, use the form provided for the CVS Caremark Mail Order Program. Additionally, please note that the Office of State Employee Benefits is implementing a new RX Maintenance Choice (w/ Opt Out) program effective January 1, 2017. This program creates efficiencies in the pharmaceutical delivery system that benefits both the state and you as the health plan member. Basically, the program encourages you to utilize the mail-order/CVS-Target pick-up options for 90-day supplies of maintenance medications and realize savings. This method saves the cost of a single co-pay, which over the course of the year can add up to several hundred dollars. Some of you and your dependents surely already participate in this program – it is currently voluntary. But beginning January 1, 2017, this program will become mandatory unless you opt out by calling CVS Caremark. See below for a description of how the program works.

To obtain reimbursement for out-of-network pharmacy claims, complete the CVS Caremark RX Claim Form and submit as instructed on the form.

To learn more about pharmacy coverage, visit the State of Rhode Island's Medical/Pharmacy Coverage page at: http://www.employeebenefits.ri.gov/benefits/active/health/prescription.php

For more information regarding Medical Insurance, please visit: http://ccri.edu/hr/handbook/302Health.html

MAINTENANCE CHOICE OPT-OUT

  • This program applies to maintenance (long-term) medications only.
  • This program does not apply to short-term/acute medications.
  • This program DOES NOT require a you to use CVS/pharmacy or Mail Service.
  • This program is identical to the current Voluntary program, however, it requires you to call CVS Caremark (1-800-307-5432) to opt out of 90-day maintenance medications.
  • This program allows flexibility and choice:
    • You can choose 90-day supply of maintenance medications at CVS/pharmacy or CVS Caremark Mail Service Pharmacy or you can call Customer Care at 1-800-307-5432 to choose 30-day supply of maintenance medications at other participating retail pharmacies. Once you call CVS, covered long-term medications can be filled at any participating retail pharmacy. You pay the retail copay for each 30-day supply.
    • There is NO REQUIREMENT under the State of Rhode Island’s prescription drug plan to use CVS/pharmacy.

HOW THE PROGRAM WORKS:

  • After one fill of a maintenance medication at any participating retail pharmacy, you will receive a letter from CVS Caremark with instructions. There are 2 separate letters depending on where you fill your medications.
    • Letter A: If you fill long-term medications at CVS /pharmacy:
      • Informs you that the CVS pharmacist will be reaching out to your doctor to obtain a new medication for a 90–day supply.
      • There is no further action required by you.
      • You will pay the lower 90-day copay for maintenance medications.
    • Letter B: If you fill long-term medications at any other participating retail pharmacy explains your choices:
      • You can choose to call your doctor, obtain a 90 day supply of your maintenance medication and fill at Mail Service or CVS/pharmacy.

OR

  • You can call CVS Caremark at 1-800-307-5432 and tell Customer Care you want to OPT-OUT of 90 day supply maintenances. Once you contact CVS to opt-out, you will be allowed to fill your maintenance prescription at any participating retail pharmacy at 30-day supply copay. You will be opted out of 90-day maintenance medications for all other maintenance medications you may be taking. This allows your eligible covered medications to be dispensed at any participating retail pharmacy without having to call CVS Caremark with every medication.

Please note that the Maintenance Drug List is intended to be illustrative and is not all-inclusive.

The CVS Caremark Flyer describes the 90-day Maintenance Choice options available to you. For those so inclined, mail order is a great way to save money and not wait in lines at the pharmacy. It is relatively hassle-free and they even schedule helpful reminder phone calls and/or text messages when re-fills are due. CVS Caremark will also facilitate your doctor providing the prescription so you don’t have to. Visit www.caremark.com/wps/portal/WELCOME_PAGE to learn more general information about the web-based services CVS Caremark offers and register an online account. The CVS Caremark home page is www.caremark.com.

This page developed and maintained by The Office of Human Resources. Send comments and suggestions to humanresources@ccri.edu.

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Last Updated: 11/6/17