Prescription Drug Benefits

BNY Mellon Benefits Guide

If you elect medical coverage through the Lower Deductible HSA Plan or the Higher Deductible HSA Plan with Aetna or UnitedHealthcare, you will automatically be enrolled for prescription drug coverage through CVS Caremark. (Those enrolled in the Kaiser Permanente, HMSA or Aetna International plans will receive prescription coverage through their medical carrier.)

The CVS Caremark prescription plan offers lower prices for generic drugs, a mail order option for maintenance medications and coverage for specialty drugs. This prescription plan also requires mandatory generic substitution.

For maintenance drugs, you have the choice of CVS pharmacy or CVS Caremark Mail Service. If you use maintenance drugs, you may fill a 30-day prescription twice at the retail level. Then future fills must be completed through the mail-order service in 90-day quantities. You also may pick up a 90-day supply through the Maintenance Choice program at any CVS pharmacy location.

Non-preventive prescription drugs are subject to the deductible/coinsurance provisions, but preventive prescription drugs are not subject to the deductible and are covered under the traditional four-tier prescription drug schedule, offering copayments for generic drugs and coinsurance for formulary (preferred), non-formulary (non-preferred) and specialty drugs. Prescription drug expenses under both health plans now count toward the out-of-pocket maximum, as required by the Affordable Care Act.

Prescription Drug Card

You will receive a prescription drug card from CVS Caremark following your enrollment. This card is separate from your medical card and should be used when you order prescriptions through either a retail pharmacy or mail order service.


2019 PRESCRIPTION DRUG BENEFITS (CVS/CAREMARK)
Retail	Preventive Drugs¹ Generic: Lesser of $10 copay or retailer's regular cost (deductible does not apply) Formulary (Preferred) Brand: 25% with $50 minimum and $75 maximum (deductible does not apply) Non-Formulary (Non-Preferred) Brand: 40% with $75 minimum and $100 maximum (deductible does not apply) Non-Preventive Drugs Generic: 20% after deductible Formulary (Preferred) Brand: 20% after deductible Non-Formulary (Non-Preferred) Brand: 40% after deductible
Mail Order²	Preventive Drugs Generic: Lesser of $25 copay or regular discount cost (deductible does not apply) Formulary (Preferred) Brand: 25% with $125 minimum and $187.50 maximum (deductible does not apply) Non-Formulary (Non-Preferred) Brand: 40% with $187.50 minimum and $250 maximum (deductible does not apply) Non-Preventive Drugs Generic: 20% after deductible³ Formulary (Preferred) Brand: 20% after deductible³ Non-Formulary (Non-Preferred) Brand: 40% after deductible³
Specialty	Generic: 20% after deductible⁴ Formulary (Preferred) Brand: 20% after deductible⁴ Non-Formulary (Non-Preferred) Brand: 40% after deductible

¹ Examples of preventive drugs include, but are not limited to, diabetes medications, cholesterol medications and high blood pressure medications.

² Medications for chronic conditions are restricted to mandatory mail order or CVS pharmacy after the prescription is filled twice at the retail level; mandatory generic; Step Therapy programs; contact CVS Caremark for additional details.

³ Must use mail order for maintenance drugs after two retail fills or pay full cost of drug at retail.

⁴ Drugs filled outside the CVS Caremark network will initially be denied, and you will be responsible to pay 100 percent of the cost. You will need to fill out an out-of-network paper claim to be reimbursed by the plan up to the out-of-network coinsurance, after deductible.

Note: CVS Caremark requires prior authorization, quantity limits and/or specialty guideline management for select medications, and these requirements may change from time to time. Current medications subject to these special guidelines are listed in the "Value Formulary Quick Reference List."

CVS Caremark Value Formulary

The Prescription Drug Formulary is updated regularly and can be accessed at info.caremark.com/highvalueplan. If you currently take prescription drugs or need prescription drugs during 2019, it is important that you review this formulary list with your doctor. If your prescribed drug is not on the list, discuss with your doctor whether your treatment plan can include a generic alternative or, if not available or tolerated, a high-quality, preferred name-brand drug included in the new Value Formulary.

CVS Opioid Management Program

CVS aligns their opioid management with the Guideline for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and Prevention (CDC) to positively influence the prescribing and use of opioids to treat pain. The program limits days' supply, limits quantity of opioids and requires step therapy. For more information, please contact CVS Caremark at 1-800-685-4130.

Compound Prescriptions

Due to the lack of U.S. Food and Drug Administration (FDA) approval for many ingredients included in compounds and the high cost of these compounded medications, they may not be covered by your prescription plan or may require a prior authorization. If the compound ingredients are not covered, you will be responsible for the full cost of those ingredients. In situations where the compound ingredients are covered through prior authorization, you will pay the share of the cost specified by your prescription benefits.

Over-the-Counter Equivalents

Prescription drugs that have an over-the-counter (OTC) equivalent are not covered by either of the BNY Mellon health plans.

Preventive Therapy Drugs

Preventive drugs are medications that can help prevent a health condition from developing. Examples include blood pressure and cholesterol-lowering medications that may prevent heart attacks and strokes. See the "Preventive Drug List".

Diabetes Discount Program

The Diabetes Discount Program provides a 50 percent discount on diabetes prescriptions and supplies. The discount is provided to all benefits-eligible participants enrolled in either the Lower Deductible HSA Plan or the Higher Deductible HSA Plan who have completed an A1C test in the prior 12 months.

Not all diabetic medications and supplies are eligible for the program discount. Certain diabetic medications and supplies are considered preventive and the discount will apply based on the applicable preventive drug copay tier. For non-preventive diabetic medications and supplies, the 50 percent discount will not apply until the annual deductible has been met. The discount does not apply to any medications on the CVS Caremark Value Priced Generics Drug List.

If you have questions regarding this program, the specific coverages for diabetic medications and supplies, or the testing requirements, please call CVS Caremark at 1-800-685-4130.

Specialty Drug Services

Specialty drugs are prescriptions that are used for the treatment of complex, chronic conditions such as hepatitis, hemophilia, and cancer.

CVS Caremark offers a program for specialty injectable and oral drugs that can provide you with greater convenience, including express delivery, follow-up care calls, expert counseling and superior service. Specialty medications (excluding HIV and transplant therapies) are no longer eligible for a grace fill at non-CVS retail pharmacies or other non-CVS specialty pharmacies. A one-time annual grace fill is available for HIV and transplant therapies. All other specialty prescriptions must be filled through CVS Specialty, and will be accepted at all CVS retail pharmacies. Also, CVS pharmacy locations with a MinuteClinic® have a service that provides education regarding the medication or the injectables you are taking.

Step Therapy Program

The prescription drug Step Therapy program helps ensure that you receive appropriate, safe and cost-effective drug therapy. Step Therapy encourages the use of therapies that should be tried first, before other treatments are covered, based on clinical practice guidelines and cost-effectiveness.

If your doctor prescribes a brand-name drug for the treatment of an ongoing condition, you will be required to try a medically equivalent but lower-cost alternative to the drug first. You will be contacted before implementation of Step Therapy with a list of the alternative drugs available. After you review the list, you or your pharmacist may contact your doctor to approve the change. If your doctor does not authorize the switch to the preferred drug, the request will be clinically reviewed and you will be informed of the outcome.

Review the CVS Caremark Value Formulary with your doctor if you are being treated for an ongoing condition. Your doctor will help you determine whether your treatment plan can include a generic alternative or, if not available or tolerated, a high-quality preferred brand-name drug included in the Formulary. Please see the "Value Formulary Quick Reference List."

Dispense as Written (DAW) Provision

Sometimes, your doctor may determine that it is medically necessary for you to take the brand-name version of a drug, even if a generic version is available. If so, your doctor would write "DAW" at the bottom of the prescription. This means that your prescription must be filled with the brand-name version of the medication.

If you use a DAW prescription and receive a drug's brand-name version, you will be required to pay the brand copayment plus the cost difference between the brand and generic drug. If you are unable to take a generic equivalent drug for clinical reasons (e.g., you are allergic to the generic filler), your physician can appeal. If your appeal is approved, you can take the brand-name drug without paying the differential.

CVS Caremark Resources and Savings

CVS Caremark offers innovative online solutions at www.caremark.com, using a secure, encrypted web environment for transactions and information to empower you to make cost-effective and informed health care decisions. Online features include:

fast and convenient mail service for new prescriptions and online refills;

expedited new prescription mail service orders with Fast Start;

your prescription history;

tools that allow you to check for lowest-price options;

Ask-a-Pharmacist and Customer Care to answer your questions;

information about drug interactions with other drugs, vitamins and foods; and

health information about specific conditions through Self-Care Centers.

Go to www.caremark.com/register to get started. It's a fast, free and easy way to make the most of your prescription drug coverage.