Prescription Drug Program
Description of Benefits
Inclusive Health has the following prescription drug benefit tiers and copayments for a covered prescription of up to 30 days:
- Generic Drugs = $10 Copayment
- Preferred Brand Drugs = $35 Copayment
- Non-Preferred Brand Drugs = $50 Copayment
- Specialty Drugs = $250 Copayment
- Annual benefit maximum of $100,000 for specialty drugs
Retail Network
Inclusive Health’s prescription drug benefit and network are managed by Caremark, which includes over 2,000 retail pharmacies across North Carolina. To find a participating pharmacy near you, please review the retail pharmacy link on www.caremark.com. Present your Inclusive Health identification card at a participating pharmacy along with your prescription.
Mail Order
Inclusive Health offers mail order pharmacy services through Caremark. Click on Caremark to find out the details.
Specialty Drugs
Prior Authorization Requirements: A list of prescription drugs for which Inclusive Health requires a prior authorization can be found at www.caremark.com.
Prescription Assistance Programs
In the event that you exceed your annual dollar benefit maximum for specialty drugs of $100,000, you may be eligible for a prescription manufacturer’s Prescription Assistance Program (PAP). PAPs offer free or low-cost prescription drugs to eligible individuals typically with annual incomes below 200% of the federal poverty level. You’ll find more information about PAPs at www.rxassist.org.