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, all you need to do is 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, please feel free to contact the Benefits Hotline at 317-232-1167 or toll free at 877-248-0007 (if outside of Indianapolis).
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.
