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SAG - AFTRA Health Plan and CVS Caremark

Prescription Drug Deductibles and Copays

- Calendar Year Deductible

Plan I $75 person/$150 family;

Plan II $175 person/$350 family

Plan I $75 person/$150 family;

Plan II $175 person/$350 family

- Supply Per Prescription or Refill

Up to 30 days

Up to 90 days

Generic Medication

Best option to help you save money

$10 or 10% (Higher of)

$20 or 10% (Higher of);
max copay is $50/prescription

Preferred Brand-Name Medications

Best option when a generic isn't available

$25 or 25% (Higher of)

$50 or 25% (Higher of);
max copay is $125/prescription

Non-Preferred Brand Name

Highest cost option

$40 or 40% (Higher of)

$100 or 40% (Higher of);
max copay is $300/prescription

  • In addition to the maximum copays listed above, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

 

  • Generic preventive services medications, including contraceptives, are covered at 100 percent with no deductible or copay.
  • In addition to the maximum copays listed above, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

 

  • Generic preventive services medications, including contraceptives, are covered at 100 percent with no deductible or copay.
- Specialty Medications

Enrolled in PrudentRX

$0 Copay 

$0 Copay

Generic (not enrolled in PrudentRX)

30%

30%

Preferred Brand (not enrolled in PrudentRX)

30%

30%

Non-Preferred Brand (not enrolled in PrudentRX)

30%

30%


  


Check Drug Cost and Coverage

Enter the drug name, choose your prescribed amount and search. You'll be able to see how much your medication costs, as well as any other options your plan covers, like a generic.

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Plan 1 

Plan 2