• HealthSelect Prescription Drug Program

    Costs displayed are effective September 1, 2011 - August 31, 2012.

    Costs are based on using network pharmacies. Your costs at non-participating pharmacies will be higher. HMO participants do not have benefits with non-participating retail pharmacies.

    Each participant must pay a $50 annual deductible (per plan year) before copays apply.


  • Retail Pharmacy Prescription Drug Costs

    Tier 1 Tier 2* Tier 3*

    $15 for up to 30-day supply
    (non-maintenance medication)

    $20 for up to 30-day supply
    (maintenance medication)

    $35 for up to 30-day supply
    (non-maintenance medication)

    $45 for up to 30-day supply
    (maintenance medication)

    $60 for up to 30-day supply
    (non-maintenance medication)

    $75 for up to 30-day supply
    (maintenance medication)

    *Cost is based on if a generic is not available. If a generic is available and you chose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.

  • All Carrier Mail Order/HealthSelect EDS* Prescription Drug Costs

    *These costs also apply when using the HealthSelect Extended Days Supply (EDS) Pharmacy Network. Find participating pharmacies on the Caremark website.

    Tier 1 Tier 2* Tier 3*

    $30 for 31-60 day supply

    $45 for 61-90 day supply

    $70 for 31-60 day supply
    (generic not available)

    $105 for 61-90 day supply
    (generic not available)

    $120 for 31-60 day supply
    (generic not available)

    $180 for 61-90 day supply
    (generic not available)

    *If a generic is available and you choose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.