All three medical plans have prescription coverage through CVS Caremark. The three medical plans have the same copay/coinsurance amounts and a large network of pharmacies. For a full list of in-network pharmacies, please visit www.caremark.com. As a reminder, there is no requirement to switch to a CVS pharmacy. In-network pharmacies are Tier 1 providers. Prescriptions filled at in-network pharmacies are considered Tier 1 expenses and will count toward both your Tier 1 and Tier 2 deductible and out-of-pocket maximum.
90-day fills can be made at your local retail pharmacy or through mail order. However, it is important to note that the co-pay and co-insurance amounts are a little higher on 90-day fills at the retail pharmacy than through mail.
The easiest way to manage your prescriptions is through CVS Caremark’s website or mobile app. Within both platforms, you may review your mail order prescription, check drug costs and coverage, find a network pharmacy and keep track of your prescription spending. You may also transfer a current prescription or submit a new one by simply submitting a picture of the prescription label or written prescription. For additional ease, you can even enroll in automated refills. To get started, register at www.caremark.com or download the CVS Caremark mobile app.
Below is a quick look at the 2026 prescription coverage.
| Prescription Drug Coverage Deductible must be met before coinsurance rates apply | |||
|
Retail Pharmacy Network (Up to 30 day supply) |
Mail Service Pharmacy (Up to 90 day supply) |
Retail Pharmacy Network (Up to 90 day supply) | |
| Preventive Medicines (mandated by the ACA) |
$0 (no deductible) |
$0 (no deductible) |
$0 (no deductible) |
| Generic Medicines | $10 copay | $20 copay | $30 copay |
| Preferred Brand-Name Medicines |
20% Min. $30, Max. $50 |
20% Min. $60, Max. $100 |
20% Min. $90, Max. $150 |
| Non-Preferred Brand-Name Medicines |
40% Min. $50, Max. $70 |
40% Min. $100, Max. $140 |
40% Min. $150, Max. $210 |
| Specialty Medicines |
40% Min. $75, Max. $150 (30 day supply) | ||
If you have any questions about how this change will impact you, please feel free to contact the Benefits Hotline at 317-232-1167 or toll free at 877-248-0007 (if outside of Indianapolis).
Prescription Coverage Quick Links
Maximize Your Out-of-Pocket Savings on Prescription Medications
As a State of Indiana employee, you have access to benefits designed to make your healthcare more affordable and convenient. Here are some ways you can save up to thousands of dollars annually in out-of-pocket expenses on prescription medications:
- Check out CVS’s Drug Cost and Coverage tool on the CVS/Caremark website. All you have to do is create an account and use the Plan & Benefits tab to find the Check Drug Cost & Coverage tool. Use this tool to search for drugs to see plan coverage, generic alternatives and cost at your pharmacy. This means that you’re never caught off guard by the price of your medication at the counter again.
- Get 90-day prescriptions by mail for the most savings: Save time and money with a 3-month prescription for your medication. Whenever available, CVS/Caremark’s Mail Service Pharmacy costs less than retail.
- Check programs like Good Rx and Mark Cuban Cost Plus Drugs for special deals. Because these programs focus on just a few medications, they can sometimes offer an even better deal than the already discounted pricing you get through your insurance. Good Rx and Mark Cuban Cost Plus Drugs focus on low cost generic medications.
- Check the drug manufacturer’s website for discount programs. Manufacturer programs are usually for brand name medications. If you are able to take advantage of these low cost programs, you will have one extra step to take to make sure what you pay counts towards your deductible and out-of-pocket maximum.
To illustrate the potential savings, let’s look at an example:
You need to fill a prescription for a common injectable drug for inflammatory conditions which now offers a generic called a biosimilar. You decide to check CVS’s Drug Cost Tool and discover big savings if you choose home delivery through CVS/Caremark mail service for your prescription:
- Brand name: The cost is $5,884.
- Biosimilar at retail: The cost is $2,183.
- Biosimilar at mail: The cost is $1,320.
Special note to maximize your benefits while also getting the best price:
When you use GoodRx or Mark Cuban’s Cost Plus Drugs, you are filling a prescription outside of your health plan. To make sure those expenses are counted towards your deductible, or to get reimbursed for what the plan should have covered, you must submit a Prescription Reimbursement Claim Form to CVS/Caremark. You can do this electronically by logging in at www.caremark.com and navigating to Plan & Benefits > Reimbursement Claims > Submit a New Claim. Remember that the INSPD Benefits Hotline is here to help if you have any questions. Take advantage of these benefits and start saving today!
For more information on your prescription coverage and to explore the full list of in-network pharmacies, visit www.caremark.com. By making informed choices about where you fill your prescriptions, you can make a big difference in your healthcare costs. Save money, stay healthy and make the most of your benefits as a valued State of Indiana employee.
Need help with your prescription drug benefits? Contact the INSPD Benefits Hotline at 877-248-0007.
GLP-1 Drugs for Weight Loss
Effective January 1, 2026, GLP-1 drugs used for weight loss will no longer be covered under the State’s pharmacy benefit. Those currently utilizing a GLP-1 drug for weight loss will receive a letter from CVS Caremark notifying them of the change. For those currently using GLP-1 drugs for weight loss purposes:
- Talk with your doctor: This change in the State’s coverage does not mean you should stop taking your medication. Check with your doctor to determine if another covered medication such as Phentermine or Xenical will work for you. Your doctor will need to write a prescription for the different medication.
- Manufacturer savings programs: Many pharmaceutical companies offer discounts through savings programs or copay cards. These savings programs could significantly reduce the cost of the medication, which could make it more affordable to stay on the medication. Both Eli Lilly and Novo Nordisk offer direct purchasing programs. You can purchase your medication at a discounted rate, however, you will be responsible for the full cost and it cannot be applied toward your deductible and out of pocket maximum. Visit LillyDirect or NovoCare for more information.
- Medical Flexible Spending Accounts: If you are enrolled in a medical flexible spending account, it’s possible to use your benefit card to pay for your medication.
