RECEIVING YOUR PERMANENT

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Brandon Willis
5 years ago
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CARD TO BE USED UNTIL YOUR PERMANENT CARD ARRIVES FROM

1 00001 JOHN Q SAMPLE 9501 E. Shea Blvd SCOTTSDALE, AZ _PM City of Savannah 132 E. Broughton Street Savannah, GA THIS IS A ONE-TIME CARD TO BE USED UNTIL YOUR PERMANENT CARD ARRIVES FROM YOUR MEDICAL PROVIDER. PLEASE DISCARD THESE CARDS AFTER RECEIVING YOUR PERMANENT CARD IN THE MAIL. * * * *

3 What youll find inside: Your Prescription Benefit Plan Overview Where To Order Prescriptions About Your New Mail Service Mail Service Order Form * * Find more information online You can always access the most up-to-date information on your prescription benefits at Once youve registered, you can: View your plans preferred drug list Check drug costs Request new prescriptions using FastStartH Refill prescriptions Find prescription savings tips Print a claim form Be sure to have your Prescription Card with ID number with you when you register. For information about Plan Member Rights and Responsibilities, visit the Customer Care page at Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information IDX-AK

4 Your Prescription Benefit Plan Copay Overview CVS Caremark Retail Pharmacy Network CVS Caremark Mail Service Pharmacy Generic Medications Ask your doctor or other prescriber if there is a generic available, as these generally cost less. Preferred Brand-Name Medications If a generic is not available or appropriate, ask your doctor or healthcare provider to prescribe from your plans preferred drug list. Non-Preferred Brand-Name Medications You will pay the most for medications not on your plans preferred drug list. Specialty Medications Maximum Out-of-Pocket For short-term medications (Up to a 30-day supply) For long-term medications (Up to a 90-day supply) $5 for a generic $10 for a generic prescription prescription $25 for a preferred $50 for a preferred brand-name prescription brand-name prescription $50 for a non-preferred $125 for a non-preferred brand-name prescription brand-name prescription No mail order for Specialty $75 for a 30-day supply Medications $2,000 per individual for Specialty Medications 2

5 Where to fill your prescription Choosing where to fill your prescription depends on whether you are ordering a short-term or long-term medication: Short-term medications are generally taken for a limited amount of time and have a limited amount of refills, such as an antibiotic. You can fill prescriptions for these medications at any pharmacy in the CVS Caremark retail network. Choose from more than 64,000 network pharmacies nationwide, including independent pharmacies, chain pharmacies and 7,100 CVS/pharmacy locations. Find a participating pharmacy at Tip: To avoid filling out claims paperwork, bring your Prescription Card with you when you pick up your prescription, and use a pharmacy in the CVS Caremark retail network. Long-term medications are taken regularly for chronic conditions, such as high blood pressure, asthma, diabetes or high cholesterol. You will generally save money by using mail service for these prescriptions. Choose one of three easy ways to start using the CVS Caremark Mail Service Pharmacy: 1. Fill out and send in a mail service order form use the one included in this welcome kit or print one 2. Use the FastStartH tool found on 3. Call FastStart toll-free at Specialty medications can be filled at the CVS Caremark Specialty Pharmacy. Certain chronic and/or genetic conditions require special pharmacy products, often in the form of injected or infused medications. CVS Caremark Specialty Pharmacy is a comprehensive pharmacy program that provides these products directly to covered individuals along with the supplies, equipment and care coordination needed. To enroll in the benefits and services of the CVS Caremark Specialty Pharmacy, please call CaremarkConnect toll-free at or visit Customer Care If you have questions about your prescriptions or benefits, you can contact Customer Care 24 hours a day, seven days a week. You can either customerservice@caremark.com or call toll-free at For TDD assistance, please call toll-free Copayment, copay or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information BPI_5-AK_50_MOOP

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11 JOHN Q SAMPLE 9501 E. Shea Blvd SCOTTSDALE, AZ 85260! ! CVS Caremark 01 PO BOX PHOENIX, AZ or call toll-free

14 Important Information For Mail Service Pharmacy Users CVS Caremark is your new mail service prescription provider. Starting January 1, 2012, CVS Caremark will become your new provider instead of Express Scripts. Here is some important information to know about this transition: Existing refills with Express Scripts CVS Caremark will not have access to your mail service refill information until after January 1, To avoid any delay in processing during this transition, we recommend you choose one of the following: 1. Ask your doctor or other prescriber to write a new prescription for up to a 90-day supply, plus refills when appropriate. Mail this prescription to CVS Caremark using the enclosed mail service form. 2. Send your refill request after January 1, Ordering a new prescription through mail service Ask your doctor or other prescriber to write two prescriptions: one for immediate short-term use to be filled at a local network pharmacy, and one for a 90-day supply plus refills to be filled through CVS Caremark Mail Service Pharmacy. You can send in a mail order form (found at use the FastStartH tool at or call FastStart at How to order refills from CVS Caremark in the future: Once you have received your first prescription from CVS Caremark Mail Service Pharmacy, you can choose one of the following ways to request a refill: 1. Online: Log on to and register if you havent already done so. Then click on Refill a Prescription. 2. Mail: Simply complete the enclosed mail order form or find one online at 3. Phone: Call Customer Care toll-free at Medications that cannot be transferred Controlled substances and compound medication cannot be transferred to CVS Caremark Mail Service Pharmacy. If you have existing refills for these types of medications, ask your doctor or other prescriber for a new prescription and mail it to CVS Caremark. Other questions about CVS Caremark Mail Service Pharmacy? Visit to learn more about mail service, along with prescription savings ideas, health tips, and more VTL-Open_File-1111

00001 RxBIN 004336 RxPCN ADV RxGRP RX3118 Issuer (80840) 9151014609 ID NAME Temp Prescription Card 123456789 01 JOHN Q SAMPLE Present this Prescription Card to fill your prescription at any

15 00001 RxBIN RxPCN ADV RxGRP RX3118 Issuer (80840) ID NAME Temp Prescription Card JOHN Q SAMPLE Present this Prescription Card to fill your prescription at any participating retail pharmacy. For more information, visit or call a Customer Care representative toll-free at Pharmacy Help Desk for Pharmacists: Submit paper claims to: CVS Caremark Claims Department P.O. Box 52136, Phoenix, AZ ID

Your Prescription Card. Your guide for savings.

CVS Caremark 620 Epsilon Drive Pittsburgh, PA 15238 4750-_PM 9501 E. Shea Blvd SCOTTSDALE, AZ 85260 Your Prescription Card. Your guide for savings. Dear Plan Member, Welcome to your new benefits. Attached