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Drug Coverage

Our safe, convenient and cost-effective prescription drug plans provide members with:

  • A nationwide network of more than 69,000 pharmacies
  • Access to the nearly 5,000 covered drugs found on our Formularies
  • Mail Service Pharmacy—our mail order drug program
  • Coordinated medical and pharmacy care management programs to improve overall health and reduce costs
  • Personalized notices and phone calls from CVS Caremark*, our pharmacy benefit manager, detailing cost savings opportunities, safety alerts and drug education

Our Formulary (Drug List) Structure

A formulary is a list of covered prescription drugs. Our drug list is reviewed and approved by an independent national committee comprised of physicians, pharmacists and other health care professionals who make sure the drugs on the formulary are safe and clinically effective.

Within the formulary, prescription drugs are divided into tiers. Depending on your plan, prescription drugs fall into one of five drug tiers which determines the price you pay. Some plans may have 3, 4 or 5 tiers, so be sure to check your benefits information to see which tiers are included.

Members can view specific cost-share (copay or coinsurance) information by logging in to My Account or reviewing their annual summary of benefits.

The chart below describes a 5-tier drug plan:

Drug Tier (cost-share)Definition
Tier 0
$0 Drugs
Preventive drugs (e.g. statins, aspirin, folic acid, fluoride, iron supplements, smoking cessation products and FDA-approved contraceptives for women) are available at a zero-dollar cost share if prescribed under certain medical criteria by your doctor. Oral chemotherapy drugs and diabetic supplies (e.g. insulin syringes, pen needles, lancets, test strips, and alcohol swabs) are also available at a zero-dollar cost share.
Tier 1
Generic Drugs
$
Generic drugs are the same as brand-name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Generic drugs generally cost less than brand-name drugs.
Tier 2
Preferred Brand Drugs
$$
Preferred brand drugs are brand-name medications that do not have a generic equivalent. They are chosen for their cost-effectiveness compared to alternatives. Your cost-share will be more than generic drugs but less than non-preferred brand drugs. If a generic drug becomes available, the preferred brand drug will be moved to the non-preferred brand tier.
Tier 3
Non-Preferred Brand Drugs
$$$
Non-preferred brand drugs often have a generic or preferred brand drug option where your cost-share will be lower.
Tier 4
Preferred Specialty Drugs
$$$$
Preferred specialty drugs are brand-name drugs that are used to treat chronic, complex, and/or rare health conditions. Preferred specialty drugs may have a lower cost-share than non-preferred specialty drugs.
Tier 5
Non-Preferred Specialty Drugs
$$$$
Non-preferred specialty drugs have a more cost-effective preferred specialty drug alternative available.

* CVS Caremark is an independent company that provides pharmacy benefit management services.