Specialty medications – used to treat rare and costly medical conditions – are continuing to increase in cost to the state-sponsored health insurance plans every month. In fact, 40% of our total plan prescription costs are specialty medications from about 2% of plan members filling 1% of all prescriptions. Because, in aggregate, the plans had been paying 99% of the overall cost of specialty medications, the Insurance Committees that govern the benefit plans (State, Local Education, and Local Government), voted in summer 2016 to institute a 10% coinsurance on specialty medications for the PPO options, with a minimum member out-of-pocket of $50 and a maximum of $150.
For CDHP members, the regular coinsurance applies, as it always has. This helps the plan to better share the expense of costly specialty medications with plan members. Also, to help eliminate waste, the plan requires that any specialty medication only be filled for a 30-day supply. And all specialty medications must be filled through a pharmacy in the CVS Caremark Specialty Network (though not necessarily CVS Caremark’s own specialty pharmacy).
To find a specialty pharmacy, go to info.caremark.com/stateoftn and click on the “Specialty Pharmacy List” link under the Network Lists header.