How do pharmacy benefits work in a CDHP?

In the Eastman CDHP, prescription drug benefits work differently depending on whether or not you have reached the deductible. Before you reach the deductible, you will pay the full, discounted cost of your medications. Once you reach the deductible, you will pay copays/coinsurance with maximums and minimums. See the chart below for details.

  CVS/Caremark Retail  
Pharmacy Network
For short-term medications (Up to a 30-day supply)
Maintenance Choice
CVS/Caremark 
Mail Service Pharmacy or CVS retail pharmacy
For long-term medications
(Up to a 90-day supply)
Generic Medications Ask your doctor or other prescriber if there is a generic available, as these generally cost less. $10 for a generic prescription (after deductible) $20 for a generic prescription (after deductible)
Preferred Brand-Name Medications If a generic is not available or appropriate, ask your doctor or health care provider to prescribe from your plan’s preferred drug list. 20% of medication cost max of $50 for a preferred brand-name prescription (after deductible) 20% of medication cost max of $125 for a preferred brand-name prescription (after deductible)
Non-Preferred Brand-Name Medications You will pay the most for medications not on your plan’s preferred drug list. 40% of medication cost max of $100 for a non-preferred brand-name prescription (after deductible) 40% of medication cost max of $250 for a non-preferred brand-name prescription (after deductible)
Specialty Drugs Not applicable Specialty Drug Class
1-30 Day Supply
Co-Pays (After deductible)
Generic All (Tier 1) $10
Formulary Brand/Preferred Brand (Tier 2) 20%, Max $100
Non-Formulary Brand/Non-Preferred Brand (Tier 3) 40%, Max $150
Specialty Drug Class
31-90 Day Supply
Co-Pays (After deductible)
Generic All (Tier 1) $20
Formulary Brand/Preferred Brand (Tier 2) 20%, Max $225
Non-Formulary Brand/Non-Preferred Brand (Tier 3) 40%, Max $375
Injectable Diabetes Agents Not applicable You pay $0 after deductible for certain injectable diabetic agents
Refill Limit Original fill plus 1 refill None
  • You have a combined annual deductible and out-of-pocket maximum. Medical and pharmacy expenses are combined and applied toward satisfaction of the annual deductible and out-of-pocket maximum.
  • Plan pays 100% for certain preventive drugs.
  • No out-of-network benefit for pharmacy services.

Note: When a generic is available, but the pharmacy dispenses the brand-name medication for any reason, you will pay the brand copayment/cost.