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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
Pharmacy Claim Form
Performance Drug List
Specialty Pharmacy List
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.
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