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Prescription Drug Benefits Overview


For full details about the prescription drug benefits available from the DGA–Producer Health Plan, refer to the March 2025Health Plan Summary Plan Description.

Prescription Drug Network

CVS Caremark is the Health Plan’s prescription benefit manager.

To locate CVS Caremark network pharmacy, go to caremark.com or call (855) 271-6601.

Below is a summarized schedule of prescription drug benefits under the Health Plan.

Up to 30-day supplies from Participating Retail Pharmacies Up to 90-day supplies from any local CVS Pharmacy or CVS Mail Service
Deductible There is no deductible associated with the prescription drug benefit.
Allowable Quantity Up to 30-day supply Up to 90-day supply
Generic Drug Co-Payment $10 $25
Brand Name Drug Co-Payment $24 $60
Lifestyle Drug Co-Payment
(i.e., erectile dysfunction drugs, proton pump inhibitors and sleep aides.		 Greater of $40 or 50% of the
cost of the medication		 Greater of $60 or 50% of the
cost of the medication

There are special rules for coverage of proton pump inhibitors and sleep aides. See the “Lifestyle Drugs” section beginning on page 70 of the March 2025 Health Plan Summary Plan Description for more information.

Generic contraceptives are covered at 100% under the Health Plan’s Preventive Care Services benefit.

Drugs that are not listed in the CVS Caremark formulary are not covered under the Health Plan. This affects a small number of brand name medications. To find out whether your current prescription is listed, click here to view the complete formulary.

If you choose to take a brand name drug when a generic equivalent is available, you will pay the cost difference between the two drugs plus the generic co-pay.

MAINTENANCE MEDICATIONS

If you are taking a maintenance medication (three months or more), you are allowed two 30-day fills at a retail pharmacy. After the first two fills, to avoid paying the entire cost of the medication, you will be required to obtain your medication in 90-day supplies, using one of the following two options:

  1. Delivery with CVS Mail Service
    1. Ask your doctor to send an electronic prescription to CVS Caremark Mail Service Pharmacy. This is the easiest way to get started – you can expect to get your medication in 7-10 business days.
    2. Sign in or register for an account at caremark.com, and request that CVS Caremark contact your doctor and get the process started for you. Once we reach your doctor and receive approval, it will take 7-10 business days for your medication to be delivered.
  2. Local Pick-up at any CVS, Longs, or Navarro Pharmacy
    1. Obtain a 90-day prescription for your maintenance medication from your doctor.
    2. Fill your 90-day prescription in person at any CVS, Longs or Navarro pharmacy.

    For questions about the program, please call (855) 271-6601 or visit caremark.com.

For more information on maintenance medications, please refer the March 2025 Health Plan Summary Plan Description.

NON-NETWORK PHARMACIES

You may purchase your medication at a non-network pharmacy, but you will have higher costs and will have to file a claim with CVS Caremark for reimbursement.

RX SAVINGS PLUS CARD FROM CVS CAREMARK

All Health Plan participants, beneficiaries and DGA members can now obtain the RxSavingsPlus card from CVS Caremark free of charge regardless of Health Plan coverage status. With the RxSavingsPlus card, you can save on the full cost of brand name and generic medications at more than 65,000 participating pharmacies nationwide.

A few benefits of the card include:

  • discounts on many diabetic supplies
  • over-the-counter products with a doctor’s written prescription
  • certain pet medications

For more information or to sign up to receive the card, visit www.dgaplans.org/rxsavingspluscard.