Pharmacy Plan

When you enroll in a Memorial Hermann 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.

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

  • For generic prescription drugs, you pay a $10 copay for a 30-day supply or a $25 copay for a 90-day supply. There’s no deductible to meet before the plan begins paying benefits.
  • For brand-name prescriptions, you pay the full price until you meet your plan’s pharmacy deductible ($50 per covered individual). After that, you share the drug’s cost with Memorial Hermann.
  • For long-term medications, 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 GLP-1 weight loss medications, you must meet specific requirements to be eligible for coverage. When you are eligible, you will pay a $150 copy per month to fill your prescription.

Cost summary

Type of Drug

Deductible

30-day supply
(retail)

90-day supply

Generic

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

$50/individual

50% after deductible

($50 minimum, $125 maximum)

50% after deductible

($125 minimum, $315 maximum)

Specialty

$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.

Note: 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 and generic.

  • 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 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

Everything you need to manage your medications is at your fingertips. With the CVS CaremarkTM mobile app, you can easily refill prescriptions, check drug costs, submit photos of your paper prescriptions and find nearby pharmacies!

And, register on caremark.com to view the formulary and stay up to date on new ways to save.

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.