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Your Prescription Drug Benefits

When you enroll in any of the Pfizer medical plan options, you’ll automatically receive prescription drug coverage through CVS Caremark® for medications dispensed through a pharmacy. CVS Caremark provides access to over 68,000 pharmacies nationally including local pharmacies, retail store pharmacies (such as Costco and Walmart), and large pharmacy chains including CVS and Walgreens. Use the Pharmacy Locator to search in-network pharmacies.

Know Your Out-of-Pocket Costs for Covered Medications

The CVS Caremark’s Check Drug Cost Tool shows which medications are covered and estimates your out-of-pocket cost for specific medications so you can compare options, if applicable (for instance, brand versus generic, or retail versus mail service).

Prescription Drug Plan Summary Chart

Medication or Supply
HSA Copay
Network Copay and Traditional Coinsurance
Annual Deductible
$1,700/$3,400
(Combined with medical)
No deductible
Most Pfizer Medications
(when no generic is available)
No cost, after deductible; deductible doesn't apply if the medication is on the HSA Copay Preventive Drug List
No cost
Retail Medications — Per 30-day Supply
Retail Medications — Per 30-day Supply
Retail Medications — Per 30-day Supply
Non-Pfizer Generic Medication
$20 copay, after deductible; deductible doesn't apply if medication is on the HSA Copay Preventive Drug List
$20 copay
Non-Pfizer Brand Medications and Pfizer Medications (when a generic is available)
20% coinsurance after deductible (Min $20, Max $85); deductible doesn’t apply if medication is on HSA Copay Preventive Drug List
20% coinsurance (Min $20, Max $85)
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
$50 copay, after deductible; deductible doesn’t apply if medication is on the HSA Copay Preventive Drug List
$50 copay
Non-Pfizer Brand Medications and Pfizer Medications (when a generic is available)
20% coinsurance, after deductible (Min $50, Max $212.50); deductible doesn’t apply if medication is on the HSA Copay Preventive Drug List
20% coinsurance
(Min $50, Max $212.50)
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
$3,800/$7,600
(Combined with medical)
$1,750/$2,625
(Separate from medical)

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

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.

COVID-19 and Flu Test Kits

Under Pfizer prescription drug coverage, LUCIRA by Pfizer COVID-19 & Flu test kits (one test per member per month) and over the counter COVID-19 tests (8 tests per member per month) are generally covered at no cost. Note: Under the HSA Copay option, these are only covered at no cost once the plan deductible is met. Learn more.

Pfizer Medications

  • Pfizer medications with no generic available are covered at no cost to you as shown in the Pfizer Zero Cost Prescription Drug List (subject to certain IRS rules if you enroll in the HSA Copay option).
  • If you choose a Pfizer medication when a generic is available (such as Accupril, Pristiq, Protonix, and others), the medication will be covered the same as any non-Pfizer brand medication: it’s covered, but you and Pfizer share in the cost.

Important Information If You Are Enrolled in the HSA Copay Option

If you are enrolled in the HSA Copay option, IRS rules require that you pay the full cost of non-preventive medications (including any Pfizer medications) until you reach the annual deductible. However, under the HSA Copay option, exceptions apply for preventive medications as follows:

  • Medications on the Affordable Care Act (ACA) Drug List (which includes preventive vaccines) are covered at 100% even before you meet the deductible.
  • Medications on the HSA Preventive Drug List
    • For non-Pfizer medications on this list: the deductible won’t apply; you will pay your cost share.
    • For Pfizer medications on this list that have no generic available: the deductible won’t apply; medications will be covered at no cost.
  • For Pfizer medications on the Zero Cost Prescription Drug List but not on the HSA Copay Preventive Drug List, you will pay the full cost before you reach the deductible. Once the deductible is reached, you will pay no cost.
  • CVS Caremark offers an interest-free payment program for medications filled through either Caremark Mail Order or CVS Specialty™ and that cost more than $250 out-of-pocket. Contact CVS Caremark or CVS Specialty for details about this program.

Specialty Medications

Specialty medications are injectable, infused, oral, topical, or inhaled medications that often require specialized delivery, handling, monitoring, or administration.

Specialty medications may be received as a covered medical service or through the CVS Specialty Pharmacy:

  • As a covered medical service: Specialty medications — including those manufactured by Pfizer — that are administered in your home or at a provider’s office or facility are generally covered as a medical service under the Pfizer Medical Plan. Contact your medical plan administrator (Horizon or UHC) for coverage details, including pre-authorization requirements.
  • Through the CVS Specialty Pharmacy: Specialty medications not administered in your home or at a provider’s office — including those manufactured by Pfizer — must be obtained through CVS Specialty to be covered. Specialty medications dispensed through a pharmacy and not purchased through CVS Specialty won’t be covered; there is an exception for eligible fertility medications. To view the CVS Specialty Drug List, go to cvsspecialty.com and access the Education Center or call 1-800-237-2767 to request a copy; representatives are available Monday through Friday from 8:30 a.m. to 9 p.m. and Saturday from 9 a.m. to 4 p.m., Eastern time.

If you are taking a specialty medication, your medical coverage includes access to the Specialty Pharmacy Care Management Program.

Interested in medication support to help lose weight?

If you are taking, or are considering taking, certain weight loss medications (such as Saxenda, Wegovy, and Zepbound), you are required to enroll in the Healthy Weight Program through TrestleTree.

Receive Free Diabetic Supplies

Access free eligible diabetic supplies, including insulin needles and syringes, lancets and devices, and test strips, dispensed at a pharmacy if you participate in a coaching program administered by TrestleTree. See the Medical Support Programs section for program information.

What are Non-Specialty Maintenance Medications?

Non-specialty maintenance medications are typically taken on a regular or daily basis to treat long-term or chronic conditions. For a full list, log in to caremark.com.

Certain Preventive Medications

Includes certain medications considered preventive by the Affordable Care Act (ACA). These include medications 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 enroll in the HSA Copay plan, and are taking a medication on the HSA Copay Preventive Drug List (e.g. for diabetes or hypertension), the deductible won’t apply – you will pay your cost share unless it’s a Pfizer medication.

For more information, call CVS Caremark or view the Affordable Care Act (ACA) Drug List.

HSA Copay Preventive Drug List

If you enroll in the HSA Copay and you are taking a medication on the HSA Copay 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. For more information, call CVS Caremark or view the HSA Copay Preventive Drug List here.

Blood Glucose Testing Meters

Blood glucose testing meters must be purchased through the Diabetic Meter Program. To receive a meter, contact 1-800-588-4456 for program information. 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. These include insulin needles and syringes, lancets and devices and test strips.

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). These include medications 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 Copay Preventive Drug List

If you’re enrolled in the HSA Copay option and you are taking a medication on the HSA Copay 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 Copay 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 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 insulin needles and syringes, lancets and devices, and test strips.

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