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Annual Enrollment is October 14–31, 2025.Enroll in: Health & Insurance Benefits and Benefit Extras Program

2026 Prescription Drug Plan Summary Chart

See a list of prescription medications, including diabetic supplies, in the Prescription Drug Plan Summary Chart below. Specialty medications follow the generic or brand medication feature, as applicable, noted below.

Review Understanding Your Prescription Costs and Options Tip Sheet to understand what’s covered and your costs for those medications under the different medical plan options. Don’t forget to review the Zero Cost Prescription Drug List!

Medication or Supply
HSA Copay
Network Copay and Traditional Coinsurance
Annual Deductible
$1,800/$3,600
(Combined with medical)
No deductible
Most Pfizer Medications (when no generic is available) including Pfizer biosimilars
No cost, after deductible; deductible doesn't apply if the medication is on the HSA Preventive Drug List
No cost
Non-Pfizer Biosimilar Medications — Per 30-day Supply
Non-Pfizer Biosimilar Medications — Per 30-day Supply
Non-Pfizer Biosimilar Medications — Per 30-day Supply
Non-Pfizer Biosimilar Medications1
$100 copay, after deductible; deductible doesn’t apply if the medication is on the HSA Preventive Drug List
$100 copay
Retail Medications — Per 30-day Supply
Retail Medications — Per 30-day Supply
Retail Medications — Per 30-day Supply
Non-Pfizer Generic Medication
$25 copay, after deductible; deductible doesn't apply if the medication is on the HSA Preventive Drug List
$25 copay
Non-Pfizer Brand Medications and Pfizer Medications (when a generic is available)
20% coinsurance, after deductible (Min $30, Max $100); deductible doesn’t apply if medication is on the HSA Preventive Drug List
20% coinsurance (Min $30, Max $100)
Maintenance Choice Program Medications — Up to a 90-day Supply
Non-specialty maintenance medications when filled at a CVS Pharmacy or through CVS Caremark Mail Service Pharmacy.
Maintenance Choice Program Medications — Up to a 90-day Supply
Non-specialty maintenance medications when filled at a CVS Pharmacy or through CVS Caremark Mail Service Pharmacy.
Maintenance Choice Program Medications — Up to a 90-day Supply
Non-specialty maintenance medications when filled at a CVS Pharmacy or through CVS Caremark Mail Service Pharmacy.
Non-Pfizer Generic Medication
$62.50 copay, after deductible; deductible doesn’t apply if medication is on the HSA Preventive Drug List
$62.50 copay
Non-Pfizer Brand Medications and Pfizer Medications (when a generic is available)
20% coinsurance, after deductible (Min $75, Max $250); deductible doesn’t apply if medication is on the HSA Preventive Drug List
20% coinsurance
(Min $75, Max $250)
Plan Pays 100% Coverage for Other Medications
Plan Pays 100% Coverage for Other Medications
Plan Pays 100% Coverage for Other Medications
Medications on the ACA Drug List including preventive vaccines
100%
(Deductible doesn’t apply)
100%
Blood Glucose Testing Meters
100%
(Deductible doesn’t apply)
100%
Eligible Diabetic Supplies
100%
(Deductible doesn’t apply)
100%
Out-of-Pocket Maximum
$4,000/$8,000
(Combined with medical)
$2,000/$3,750
(Separate from medical)

Note: If actual cost of medication is less than the copay or coinsurance minimum, you will pay the actual cost.

1 Prior authorization is required if the biosimilar’s reference product (i.e., Humira or Stelara) is requested instead of the biosimilar; otherwise you will pay your regular cost share PLUS an additional fee of $500 per 30-day supply; this additional fee will not count toward your deductible and out-of-pocket maximum, as applicable. Currently all available biosimilars dispensed through a pharmacy are considered specialty medications and must be ordered through CVS Specialty.

Reminder: If you use an out-of-network pharmacy, you will be required to pay the full cost of the prescription (even for Pfizer medications) at the time of your purchase and then submit a claim to CVS Caremark for reimbursement. Your reimbursement, less any applicable cost share, may be less than the full cost of the prescription if the cost is over the contracted rate.

Healthy Weight Program

Coverage for weight loss medications (e.g. Wegovy, Zepbound and Saxenda) requires enrollment in the Healthy Weight Program.

Non-Specialty Maintenance Medications

Non-specialty maintenance medications are typically taken on a regular or daily basis to treat long-term or chronic conditions.

Medications on the ACA Drug List

Includes certain medications considered preventive by the Affordable Care Act (ACA), such as fluoride treatments, smoking-cessation treatments, oral contraceptives, colonoscopy prep medications, and low-dose generic statins, as well as certain over-the-counter products indicated for specific age and risk factors. Medications on the ACA Drug List (which includes preventive vaccines) are covered at 100 percent; the deductible does not apply if you enrolled in the HSA Copay plan. View the Affordable Care Act (ACA) Drug List or, for more information, contact CVS Caremark.

HSA Preventive Drug List

If you’re enrolled in the HSA Copay option and you are taking a medication on the HSA Preventive Drug List (e.g., for diabetes or hypertension), the deductible won’t apply; you will pay either your cost share, or no cost if the medication is on the Pfizer Zero Cost Prescription Drug List. View the HSA Preventive Drug List or call CVS Caremark for more information.

Blood Glucose Testing Meters

Blood glucose testing meters must be purchased through the Diabetic Meter Program. Contact CVS Caremark at 1-800-588-4456 for program information and to receive a meter. Choice of meter is subject to change.

Eligible Diabetic Supplies

Eligible diabetic supplies dispensed at a pharmacy are covered at no cost if you participate in a coaching program administered by TrestleTree. (See the Medical Support Programs section for program information.) These include needles and syringes, lancets and devices, and test strips. Call TrestleTree at 1-866-237-0967.