Pharmacy Plan

Prescription drugs can be vital to managing our health, so Memorial Hermann has partnered with a nationwide leader for our pharmacy plan. When you enroll in the MH Care or MH Care Broad Access medical plan, you automatically get prescription drug coverage through CVS Caremark.

You can fill prescriptions at any network pharmacy, including Memorial Hermann pharmacies and CVS retail stores. If you fill a prescription out-of-network, you pay 100% of the cost.

To find network pharmacies, go to caremark.com or use the CVS Caremark™ app:

Note: You may need prior authorization for certain prescriptions. Your provider and your pharmacist should let you know if prior authorization is required.

CVS Caremark Contact Information

Register at Caremark.com to make sure you can take full advantage of the tools available to help you manage your prescriptions and costs.

Download the CVS Caremark app for easy access on the go.

If you have any questions about your coverage or costs, call CVS Caremark Customer Care at 800.658.3413.

ID Cards

Aetna provides one ID card for medical and pharmacy coverage. You can also access your ID on Aetna.com or the Aetna Health app.

The amount you pay for each prescription is based on the drug and where and how you fill the prescription.

Prescription Definitions

Generic Drugs: These are drugs in which the active ingredient is the same as in brand-name drugs whose patents have expired. Generic drugs are typically less expensive than brand-name drugs and solder under a common or “generic” name.

Preferred Brand Name Drugs: These are drugs on the formulary, which is the CVS-approved list. These drugs are typically more cost effective.

Non-Preferred Brand Name Drugs: These are brand name drugs that are not on the formulary. They typically have a higher cost.

Specialty Drugs: These drugs treat rate or complex conditions and are typically higher cost medications.

Cost summary

Type of Drug

Deductible

30-day supply
(retail)

90-day supply

Generic (always ask your doctor if a generic is available — it could save you money!)

N/A

$10

$25

Preferred Brand Name

$50/individual

30% after deductible

($35 minimum, $75 maximum)

30% after deductible

($90 minimum, $190 maximum)

Non-preferred Brand 

Name (if a generic is not available or appropriate, ask your doctor to prescribe from your plan’s preferred drug list)

$50/individual

50% after deductible

($50 minimum, $125 maximum)

50% after deductible

($125 minimum, $315 maximum)

Specialty (available through Memorial Hermann Specialty Pharmacy)

$50/individual

PrudentRx Program:

$0 copay/prescription 

(30% coinsurance if not enrolled in PrudentRx for program eligible drugs) 

Specialty drugs not eligible for PrudentRx: 

$150 copay preferred* 

$200 copay non-preferred*

N/A

GLP-1 Weight Loss (e.g. Wegovy, Saxenda, Zepbound)**

$50/individual

$150 copay

N/A
* Applies for 30-day supply through retail or mail service.
** You must meet certain requirements to receive approval. Refer to the Weight Management page for details.

Notes:

  • If you choose to purchase a brand-name drug when a generic drug is available, you will be responsible for paying the brand name copay plus the difference in cost between the brand name and generic.
  • For short-term medications (e.g., an antibiotic), you can fill your prescription at any CVS Pharmacy (including those in Target stores) or any pharmacy in the network. To find pharmacies in the network visit Caremark.com or look on the mobile app. 
  • For long-term medications (e.g., for conditions like high cholesterol, high blood pressure or diabetes), you must get a 90-day supply. You are allowed two 30-day fills from any retail pharmacy for new prescriptions. After two 30-day fills, you can get 90-day supplies through:
    • Mail service: Your prescription is delivered to your door in tamper-resistant, temperature-controlled packaging. To sign up for mail service, go to caremark.com/mailservice.
    • CVS retail pharmacy (including pharmacies in Target stores). Visit your local CVS for details.
  • For specialty medications (e.g., for complex conditions like rheumatoid arthritis, hepatitis or cancer), you must fill your prescription through the Memorial Hermann Specialty Pharmacy. Visit specialtypharmacy.memorialhermann.org <link> or call 833.234.MHSP (6477). See “Ways to save on prescription drugs” below for more information on specialty medications.

CVS Caremark’s formulary

The formulary is the list of prescription drugs that CVS Caremark covers. Decisions about the drugs included on the list consider the cost, effectiveness and safety of each drug. The formulary may change as new information becomes available. Review CVS Caremark’s formulary for details.

Contact CVS Caremark Customer Care at 800.658.3413 with any questions.

Prior authorization requirements
Approval must be given for certain medications to be covered by the plan. CVS Caremark must approve the medication before you pay your copay or share of the cost. Your pharmacist or your doctor can call CVS Caremark to start the prior-authorization process.

When you pick up your prescription at the pharmacy, your pharmacist should let you know if your prescription needs prior authorization. If prior authorization is required and not approved, you will be responsible for the full cost of your prescription.

Contact CVS Caremark Customer Care at 800.658.3413 with any questions.

Step Therapy requirements
A Step Therapy program requires that you first try an alternative drug, typically a generic drug, before the pharmacy plan will cover certain drugs prescribed by your doctor.

If you are currently taking a drug that qualifies for the Step Therapy program, consult with your doctor to discuss which medication options are best for you. If any of the following applies to you, your doctor may request a prior authorization from CVS Caremark allowing you to take the drug as prescribed.

  • You have already tried the “first-step” generic drugs covered in the program;
  • You are allergic to the “first-step” drugs; or
  • Your doctor, for medical reasons, has decided that the brand-name drug is the best option.

Once the drug is approved, you pay the appropriate our-of-pocket cost for the drug. If the prior authorization is not approved, you will need to pay the full price of the drug.

Contact CVS Caremark Customer Care at 800.658.3413 with any questions.

  • Contribute to a Health Care Flexible Spending Account (FSA) and use pre-tax dollars to pay for your prescriptions. 
  • Talk to your doctor about prescribing generic drugs and medications included on the formulary (a list of medications that are proven to be effective and cost efficient).
  • For mail service of a 90-day supply for long-term (maintenance) medications only: If you have difficulty paying for the prescription in full, you have the option to spread payments over three months. Prescriptions picked up from a retail pharmacy are not eligible for this payment option.

Saving money on specialty medications

Specialty medications are high-cost prescriptions used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis.  

CVS Caremark partners with PrudentRx to offer a program that can reduce your out-of-pocket cost for covered specialty medications. The PrudentRx Copay Program allows you to get any of your covered specialty medications that are on the plan’s Exclusive Specialty Drug List for $0 out-of-pocket when you fill your prescription through CVS Specialty®. 

PrudentRx will work with you and the drug manufacturers to get copay card assistance and will manage enrollment and renewals for those copay cards on your behalf. Even if there is no copay card program for your medication, your out-of-pocket cost will be $0 for your covered specialty medications under the PrudentRx Copay Program. You will need to speak with a PrudentRx advocate to enroll in the program. If you do not enroll in this program, you will be responsible for 30% of the cost of your specialty medications.

If you are eligible for the PrudentRx Copay Program, they will reach out to you. 

For more information, contact PrudentRx at 800.578.4403, Monday through Friday, from 7:00 a.m. to 7:00 p.m. CT.

Two Valuable CVS Programs Will Help You Save Money!

ExtraBucks®

You can earn ExtraBucks® when you use your ExtraCare Health Card when shopping at a CVS Pharmacy® or on CVS.com.

ExtraCare+

For $5 per month, ExtraCare+ offers: 

  • Free same-day delivery of prescriptions and “front-store” items
  • Free shipping from CVS.com
  • A 20% discount on CVS Health brand products 
  • Access to a 24/7 prescription management hotline to contact a pharmacist
  • $10 to spend each month to thank you for being a member

The Transform Diabetes Care Program through CVS provides an individualized care and management experience that includes:

  • The use of advanced analytics to uncover opportunities to improve your health.
  • Coordination with your providers so they can provide additional support.
  • A free blood pressure cuff so you can monitor your hypertension at home.
  • A communication plan tailored for your health situation and preferences. Whether virtually or in person, you’ll have access to care how, where and when you need it.
  • Access to the Health Optimizer® app for digital coaching, diet and nutrition support, help managing your medications and more.

If you are eligible for this program, CVS will contact you.

Events