Prescription Drug Coverage Information/Forms
Prescription Drug Coverage
Prescription drug coverage is included in all health plan options and is provided through Caremark. You must purchase prescription drugs using your Health Plan Identification Card at participating pharmacies. The plan will pay 100% of eligible charges after the plan has paid $4,000 for one individual ($12,000 for family).
- At UUH&C Pharmacies you pay 20% (minimum $3) for covered generic and brand name prescription drugs.
- At Non-UUH&C Participating Pharmacies you pay 25% (Minimum $3) for covered generic and preferred brand name prescription drugs and 35% (minimum $3) for covered non-preferred brand name prescription drugs.
- At Non-Participating Pharmacies you pay 100% of the cost, then submit receipts to Caremark. The plan will reimburse up to the amount it would have paid at a participating pharmacy. Please see Reimbursement Process below for instructions.
Please note: If a generic drug is available, but you choose to purchase the name brand, the plan will pay its share of the generic cost.
For more information, visit the University's Caremark website.
Coordination of Prescription Drug Benefits
The University Employee Health Care Plan only allows coordination of benefits for prescription drugs between two University plan enrollees. To be eligible for coordination of prescription drug benefits, individuals must either have health coverage as an employee of the University and be covered as the spouse of another University employee, or be covered as a dependent child by two University employees. Caremark has set up a separate COB group for eligible individuals in the Employee Health Care Plan. Those in the COB group are not required to pay a coinsurance amount when they purchase a covered prescription at a participating pharmacy, eliminating the need to file a paper claim for reimbursement under secondary coverage.
To be added to the COB group, complete the Certification of Dual University Coverage for Coordination of Prescription Benefits form, and return it to the University Benefits Department. (Only one form is required per family, but both employees must sign the form.) Only employees who cover the same children may be added to the COB group. If one employee covers a child that the other employee does not cover, you must pay your coinsurance at the pharmacy and file a paper request reimbursement.
Employees and any covered dependent children are only eligible for coordination of prescription drug benefits as long as both employees continue coverage for each other (and any covered dependent children) through the University. If one of the coverages is cancelled, employees must notify the Benefits Department immediately.
Reimbursement Process
If you visited a non-participating pharmacy or purchased your prescription without your Health Plan Identification Card and paid the full cost of your prescription, you will need to do the following in order to obtain reimbursement:
- Complete Caremark's Prescription Reimbursement Claim Form located at
https://www.advancerx.com/ms/content/standard.pdf
- Complete only the Insured Information section with the secondary cardholder's information and the Patient Information section
- If all necessary information is included on the receipt (including days supply), you do not need to complete the Prescription Claim Information section; however, if any of the information is missing on the receipt, please provide it in the Prescription Claim Information section
- The pharmacist does not need to sign the form if all information is provided (form asks for pharmacist's signature, but not needed)
- Send the completed form with your prescription receipts to the address on the bottom of the form
- Keep a copy of the form and your original receipts for your records
- If you have any questions, please contact:
University Benefits Department (801) 581-7447
Caremark Customer Care Department (800) 966-5772
Coordination of Prescription Drug Reimbursement Process
If you visited a participating pharmacy and used your Health Plan Identification Card and paid your coinsurance amount, you will need to do the following in order to obtain reimbursement:
- Complete the Caremark Standard Claim Form: https://www.advancerx.com/ms/content/standard.pdf
- Complete only the Insured Information section with the secondary cardholder's information (the card that was not originally used to purchase the prescription) and the Patient Information section.
- Attach the receipt for the prescription purchased. If all necessary information is included on the receipt (including days supply), you do not need to complete the Prescription Claim Information section; however, if any of the information is missing on the receipt, please provide it in the Prescription Claim Information section.
- The pharmacist does not need to sign the form if all information is provided (form asks for pharmacist's signature, but not needed).
- Please keep a copy of the Claim Form and your original receipts for your records.
- If you have any questions, please contact:
University Benefits Department (801) 581-7447
- Complete the Coordination of Prescription Benefits Claim Form
- Send the completed forms with your prescription receipt(s) to the following address:
Caremark
Attention: Chad Madden, Client Advocate
9501 East Shea Boulevard
Mail Code 005
Scottsdale, AZ 85260-6719
- Keep a copy of the forms and your original receipts for your records
- If you have any questions, please contact:
University Benefits Department (801) 581-7447
Caremark Customer Care Department (800) 966-5772
Mail Order Information
Mail order service is available through the UUH&C South Jordan Health Center. To initiate this service call them at 801-446-4150 between the hours of 8:30 a.m. and 5:30 p.m. Monday - Friday. You may also e-mail them from the UUH&C website.
Mail order through Caremark is only available to Retirees and Health Plan participants (including COBRA participants) who reside outside the state of Utah. Print out and submit the Mail Service Order Form located at the Caremark website.
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