FORMERLY REPRESENTED RETIREES
Administered by CVS Caremark, prescription drug coverage includes medically necessary drugs and medicines prescribed by your or your covered dependent’s doctor on an outpatient basis.
You’re automatically enrolled in prescription drug coverage if you are enrolled in:
Review the Medical Expense Plan Summary Plan Description (SPD) for details.
Note: If you’re eligible for Medicare, you can’t participate in both Medicare Part D and Nokia-sponsored retiree prescription drug coverage at the same time. If you enroll in Medicare Part D, your Nokia-sponsored retiree prescription drug coverage will end. You may re-enroll in Nokia-sponsored retiree prescription drug coverage after you have disenrolled from Medicare Part D.
You can fill prescriptions:
To find an in-network retail pharmacy, visit Caremark.com (you will need to register the first time you visit the site) or call
You can fill prescriptions (up to a 30-day supply) for acute conditions at any retail pharmacy, although you will save money when you use an in-network pharmacy. Note that your prescription drug copayment will double after the third time you receive up to a 30-day supply of a maintenance medication at a retail pharmacy, unless a state exception applies. See “For Maintenance Medications for Chronic Conditions (Up to a 90-Day Supply)” below for information about state exceptions to this doubling of copayments.
For example, unless a state exception applies, if you are receiving a preferred-brand drug for high blood pressure, you will pay a $120 copayment (2 × $60 = $120) for up to a 30-day supply the fourth time you try to fill the prescription at an in-network retail pharmacy.
In contrast, you can get a 90-day supply for only $150 if you use the Mail Service Pharmacy, a CVS retail pharmacy or any Costco Pharmacy to fill your prescription.
If You Use an Out-of-Network Retail Pharmacy
When you use an out-of-network retail pharmacy to fill a prescription, you need to meet a separate prescription drug deductible before the plan will pay a percentage of the cost. You will need to pay the entire cost at the time of purchase. You will then need to file a claim with CVS Caremark to receive reimbursement for a percentage of the cost (if applicable).
To fill prescriptions (up to a 90-day supply) for any medications you or your covered dependents use on an ongoing basis for a chronic condition, such as high blood pressure or high cholesterol, at mail order pricing, you can:
As mentioned above, unless a state exception applies, prescription drug copayments for 30-day supplies of maintenance medications will double after the third time you receive such a 30-day supply at a retail pharmacy.
For current state exceptions to this doubling of copayments, see the Medical Expense Plan Summary Plan Description (SPD) for your Nokia medical plan option. These state exceptions are subject to modification from time to time, and additional states may enact their own exceptions in the future.
For a complete list of participating pharmacies you can use to fill 90-day prescriptions at mail order pricing, go to www.Caremark.com/PharmacyLocator.
To Learn More About Your CVS Caremark Prescription Drug Benefits
Refer to the following resources:
Prescription drug coverage premiums are included as part of the medical coverage premiums you may pay. Your out-of-pocket costs vary depending on how you choose to fill your prescriptions. For instance, if you purchase a brand-name drug when a generic equivalent is available, you will pay the generic copayment, plus the difference in cost between the brand-name and generic drug.
Please note that the prescription drug deductibles and out-of-pocket maximums are separate from those for your retiree medical coverage option. For your specific costs, visit the YBR website.
