Prescription Drug Benefits

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Prescription drug coverage under all four Assurant medical plans is administered by CVS Caremark. The CVS Caremark network includes major pharmacy chains, CVS Pharmacy locations inside Target stores, and many independent pharmacies. Mail service is also available for eligible maintenance medications.

When you use an out-of-network pharmacy, you may be responsible for your regular cost share plus any difference between the pharmacy’s charge and CVS Caremark’s discounted price. Certain medications, including some compound medications, may require prior authorization. Drug coverage, formulary placement, and prior authorization requirements may change during the year. Visit CVS Caremark to review coverage for a specific medication. To obtain information on a particular medication(s), log on to caremark.com.

2027 Prescription Drug Coverage

	Retail (30-day supply)			Mail order prescriptions or retail maintenance prescriptions at a CVS pharmacy (90-day supply)
Type of Medication	Coinsurance	Minimum per prescription	Maximum per prescription	Coinsurance	Minimum per prescription	Maximum per prescription
Generic¹	20%	$0	$50	20%	$0	$125
Preferred brand	30%	$15	$100	30%	$30	$200
Non-preferred brand	50%	$40	$150	50%	$80	$300
Specialty*	30%	$75	$200	30%	$75	$200
Fill Limit for Long-Term Medications²	Two fills on long-term maintenance medicines only	None

*Specialty footnote: The $75 minimum and $200 maximum apply to non-PrudentRx-eligible specialty medications. Members prescribed a PrudentRx-eligible specialty medication who do not complete applicable program requirements may be responsible for 30% coinsurance without a minimum or maximum limit.

2026 Prescription Drug Coverage

Tier 1: Generic - generic drugs must have the same active ingredients as the original brand name drug.

Tier 2: Preferred brand - brand name drugs listed on the CVS formulary/covered drug list.

Tier 3: Non-preferred brand - brand name drugs not listed on the CVS formulary/covered drug list.

See the chart below for coverage by each tier.

	Retail (30-day supply)			Mail order prescriptions or retail maintenance prescriptions at a CVS pharmacy (90-day supply)
Type of Medication	Coinsurance	Minimum per prescription	Maximum per prescription	Coinsurance	Minimum per prescription	Maximum per prescription
Generic¹	50%	$0	$50	50%	$0	$125
Preferred brand	50%	$15	$100	50%	$30	$200
Non-preferred brand	50%	$40	$150	50%	$80	$300
Fill Limit for Long-Term Medications²	Two fills on long-term maintenance medicines only	None

¹Under all Health Plans, generic preventive prescriptions are covered at 100%, and brand name preventive prescriptions are not subject to the plan’s deductible. Under the Blue, Green, and Orange plans, all non-preventive prescriptions are subject to the plan’s deductible. Under the Purple plan, prescriptions are not subject to the deductible. Caremark periodically reviews their formulary. Certain formulary medications may be excluded from coverage from time to time and impacted members will be notified.

²For long-term maintenance medications, the plan allows for two 30-day fills of maintenance medications at any pharmacy in the CVS Caremark network. After that, the plan will cover maintenance medications only if you have 90-day supplies filled through mail-order or at a CVS Caremark Pharmacy. Specialty medication supply is limited to 30 days.

CVS Caremark Formulary

Coverage for prescription drugs under all four health plans is administered by CVS Caremark. The prescription plan has a wide variety of safe and effective generic and brand medications, covering treatments for all types of injuries and illnesses.

Caremark periodically reviews their formulary or covered drug list. Certain formulary medications may be excluded from coverage from time to time and impacted members will be notified directly by CVS Caremark. The health plans include three tiers of prescription coverage: generic, preferred brand and non-preferred brand. The cost you pay per prescription is based on the tier your medication is in.

By using generic or preferred brand medicines, you can help make sure you get better value based on your plan and individual needs. You can also visit caremark.com to review the formulary lists or see resources below.

Preventive Medications

Certain preventive medications are covered at no cost when plan requirements are met. Generic medications included on the CVS Caremark preventive drug list are generally covered at 100% and are not subject to the deductible.

Coverage may vary based on the medication, formulary tier, intended use, and applicable age, clinical, and eligibility requirements. Review the current preventive medications list or visit CVS Caremark to confirm how a specific medication is covered.

Non-Preventive Medications

Beginning January 1, 2027, the amount you pay for a non-preventive prescription will depend on the medication’s tier: Tier 1 generic, Tier 2 preferred brand, Tier 3 non-preferred brand, or Tier 4 specialty.

Blue, Green, and Orange Plan participants must meet the applicable deductible before the plan begins paying benefits for non-preventive prescription medications. You will continue to receive CVS Caremark’s negotiated pharmacy rates before the deductible is met. After any applicable deductible is met, you will pay the coinsurance associated with the medication’s tier, subject to the minimum and maximum amounts shown below.

Maintenance Medications

If you take medication regularly to manage a chronic condition, you may be required to fill the prescription in a 90-day supply through CVS Caremark Mail Service Pharmacy or an eligible CVS Pharmacy location, including CVS Pharmacy locations inside Target stores.

The plan generally allows two 30-day fills of a maintenance medication at a CVS Caremark network pharmacy. After the second fill, the medication must generally be filled in a 90-day supply through CVS Caremark Mail Service Pharmacy or an eligible CVS Pharmacy location for continued plan coverage. Specialty medications are limited to a 30-day supply. If you continue filling a required maintenance medication in a 30-day supply after the two permitted fills, you may be responsible for the full cost . Contact CVS Caremark to confirm whether your medication is subject to this requirement.

CVS Caremark’s Mail-Order Service

CVS Caremark Mail Service Pharmacy provides eligible maintenance medications in 90-day supplies, with standard shipping at no additional cost. Your cost is based on the medication’s formulary tier and the applicable 90-day coinsurance, minimum, and maximum shown in the coverage chart. Visit CVS Caremark or call 1-866-587-4799 for assistance.

PrudentRX Specialty Medication Program

Beginning January 1, 2027, PrudentRx may help eligible employees and covered family members lower the amount they pay for certain specialty medications. Eligible participants are automatically enrolled, although some manufacturer copay assistance programs may require additional information or action. Most participating members will pay $0 for a covered PrudentRx-eligible specialty medication after any applicable deductible is met.

Because the Green and Orange Plans are high-deductible health plans, participants must meet the applicable deductible before the PrudentRx benefit applies to an eligible non-preventive specialty medication. Blue and Purple Plan participants can receive the PrudentRx benefit without first meeting a deductible. Preventive medications follow the plan’s preventive benefit design.

If your medication is eligible, PrudentRx may contact you directly. Members who do not provide required information or complete applicable program steps may be responsible for 30% coinsurance without a per-prescription minimum or maximum.

GLP-1 Coverage and Weight-Management Support

We remain committed to supporting employees in achieving healthy, sustainable weight-management goals. Beginning January 1, 2027, GLP-1 medications prescribed solely for weight loss will no longer be covered under the prescription drug plan, and the CVS Weight Management Program will be discontinued. However, employees will continue to have access to comprehensive weight-management support through subsidized Weight Watchers, Personify Health coaching, and Anthem nutrition resources.

Coverage will continue for GLP-1 medications prescribed for diabetes and certain other clinically supported conditions when applicable plan requirements and prior authorization criteria are met. Other medically necessary non-GLP-1 weight-management medications may also remain covered.

Employees and family members affected by this change will receive transition information and are encouraged to speak with their healthcare provider about treatment options.

Dispense as Written Guidelines

To encourage the use of cost-effective FDA-approved generic equivalents, when a prescribed brand name drug has a generic equivalent, you'll receive the generic equivalent unless your physician specifies Dispense as Written, or DAW, on the prescription. If your physician does not specify DAW and you select the brand name drug, you'll pay your share of the cost plus the difference in price between the brand name drug and the generic drug. You will never pay more than the actual cost of the drug, but you may pay more than the plan’s per-prescription maximum.

Filling Your Prescription at an Out-of-Network Pharmacy

If you fill a prescription at an out-of-network pharmacy, you will pay the full price at the point of sale and submit a paper claim to CVS Caremark for reimbursement of covered expenses. You may be responsible for your regular cost share plus any difference between the pharmacy’s charge and CVS Caremark’s discounted price.

CVS Caremark's Cost Saver

Cost Saver, powered by GoodRx, may help lower the cost of many commonly prescribed generic medications. Present your combined Anthem and CVS Caremark member ID card at a participating in-network pharmacy. The program will apply the available eligible price under the program.

For more information click here.

Rx Savings Solutions

Rx Savings Solutions (RxSS) is a free and confidential service that provides personalized opportunities to help you and your covered family members save money on prescription medications. You can compare prices, receive savings alerts after activating your account and opting in, and discuss lower-cost options with your healthcare provider. Rx Savings Solutions is an additional savings resource and does not replace CVS Caremark prescription drug coverage.

Click here for a 2-minute overview video.

RX Savings Solutions contact information: 1-800-268-4476 | Activate your account | Email Support

All Assurant medical plans include prescription drug coverage, along with tools and programs designed to help you save money on medications. Resources like Rx Savings Solutions and Prescription Cost Saver can help lower your out-of-pocket prescription costs and make medications more affordable.