CVS Caremark outlines 2026–27 prescription benefits for Group Insurance Commission members

A CVS Caremark representative, who identified the company as the plan’s pharmacy benefits manager, presented details of the Group Insurance Commission’s 2026–2027 prescription benefits and enrollment options.

The presentation matters because many plan members rely on prescription coverage for ongoing care and new enrollment rules affect how and where they can fill maintenance medications. The representative said copays and core cost-sharing are unchanged for the coming plan year and highlighted digital tools and a specialty-drug enrollment program to reduce out-of-pocket costs.

“Keeping your medication affordable is important,” the CVS Caremark representative said, and urged members to register at caremark.com or in the CVS Caremark mobile app to view plan details, cost estimates and formulary lists. The representative noted that new users may register on or after July 1, 2026, and returning members can use the member ID on their ID card to set up an account.

The presenter listed the copay schedule the plan will use once a member’s deductible is met: Tier 1 (typically generics) is $10 for a one-month supply and $25 for a three-month supply; Tier 2 (preferred brands) is $30 for a one-month supply and $75 for a three-month supply; Tier 3 (non-preferred brands) is $65 for a one-month supply and $165 for a three-month supply. The representative added that if the medication’s cost is lower than the copay, members pay the lower cost.

On preventive drugs, the presenter said, “If you fill a prescription for one of these medications, you’ll pay $0 even if your deductible is not met,” referring to medications on the ACA preventive-services drug list. The representative also described the plan’s deductible and maximum out-of-pocket (MOOP) rules, noting that prescription costs count toward the prescription deductible while both medical and prescription costs count toward the MOOP. The presenter reminded members that deductible and MOOP amounts reset at the start of each plan year.

For maintenance medications used regularly for conditions such as high blood pressure, diabetes or asthma, the plan offers a maintenance choice: members can obtain 90-day supplies by mail or at CVS pharmacy at the same cost. Members who wish to keep filling 30-day supplies at a non-CVS pharmacy have two grace fills before the 90-day requirement applies; to continue 30-day fills they must call customer care to request an opt-out, and the opt-out must be renewed at each plan renewal.

The representative said CVS Caremark is working with Prudent RX for specialty medications: after enrolling in the Prudent RX program and once any applicable deductible amounts are met, out-of-pocket specialty medication costs would be reduced to $0 for participating members. Members who do not enroll or who opt out of the program would be responsible for 30% of specialty medication costs.

The presentation closed with enrollment guidance and contact information. Members were encouraged to visit the plan microsite for details, register for caremark.com or the CVS Caremark mobile app, and call customer care at 1-877-876-7214 (option 2) with questions.