Prescription Drug Benefits

 

Prescription Drug Benefit Summary

Your Caterpillar prescription drug benefit offers you the convenience of using retail pharmacies, mail order pharmacy services through Walgreens Mail Service, and specialty pharmacy services through Prime Therapeutics Pharmacy.

 

Caterpillar Drug Formulary

Our prescription drug plan includes the Caterpillar Drug Formulary, or list of covered medications. If your medication isn’t listed on the formulary, you may want to ask your doctor for alternative medications that are covered under the plan. The formulary is updated quarterly with changes, additions or removals. Click the quarterly update link below for the latest formulary updates.

Our prescription drug benefit is based on a tier system: the lower the tier your medication is in, the less you pay.

Copay vs. coinsurance:
Copay = you pay a flat dollar amount
Coinsurance = you pay a percentage of the cost

You can also save money with Tier 0 medications. Medications on the $0 Prescription Drug List have been determined to be "best in class" and most cost-effective, so they're offered for a $0 copay if filled at a network pharmacy.

 

Preventive Drug List for Consumer-Directed Health Plans

If you’re enrolled in the UHC Consumer Choice or UHC Consumer Max plan, prescription medications under the plan count toward your deductible. This means you pay the full contracted cost of prescriptions until you meet your deductible each year.

Certain preventive medications on Caterpillar’s CDHP Preventive Drug List are covered before you meet the deductible. Instead, you’ll pay the copay or coinsurance amount without having to first meet the deductible.

 

Prior Authorization

Certain medications require a prior authorization review. Prior Authorization means a set of criteria must be met and a drug-specific form must be completed for the medication to be considered for coverage by the plan. Once a coverage determination has been made, the member and physician will be notified.

Click here to view the list of Prior Authorization Forms.

 

Retail pharmacies
Make the most of your prescription drug benefits by using network pharmacies: Walmart, Kroger, Walgreens, and CPRxN pharmacies. Network pharmacies provide the best value to Caterpillar participants and may prevent you from paying a higher copay or coinsurance amount charged for using an out-of-network pharmacy.

Mail order (home delivery)
Walgreens Mail Service is Caterpillar's home delivery service. Home delivery service may be right for you or a covered family member if your physician prescribed a maintenance medication and anticipates long-term use, you are stabilized on a given dosage, you travel often or have difficulty getting to a retail pharmacy. Maintenance medications treat conditions such as high blood pressure, arthritis, heart ailments or diabetes. The mail order (home delivery) program allows you to order up to a 90-day supply of your long-term maintenance medications that are conveniently delivered to your door. You can order in one of three ways:

  • Online. Visit WalgreensMailService.com
  • By phone. Call 1-866-840-1222 (TTY: 1-800-925-0178)
  • By mail. Complete a Home Delivery Registration & Prescription Order Form and mail it along with the prescription and copay to the address at the bottom of the form. If payment or credit card information is not included, the prescription may be returned unfilled. Call Walgreens Mail Service to determine copayment.Allow 10 business days from the day you mail it to when you’ll receive the medication (Your doctor can also fax in the prescription by using the Prescriber Fax Form).

Refills
After you receive your first mail order prescription, you can request refills 24/7 by visiting the Walgreens Mail Service website or by calling 1-866-840-1222. Be sure to have the prescription number, store number and credit card information ready. This information can be found on the prescription bottle label.

Walgreens Mail Service brochure

Specialty pharmacy
Certain high-cost prescription medications treat complex conditions and require special handling.  Medications on the Specialty Product List must be purchased through Prime Therapeutics Pharmacy. For more information, contact Prime Therapeutics Pharmacy at 1-866-554-2673.

 

Find network pharmacies

Network pharmacies provide the best value to Caterpillar participants. Caterpillar has negotiated aggressive pharmacy pricing agreements with network pharmacies to help lower prescription medication costs and provide transparency. Also, if you're prescribed a Tier 1 medication, you'll benefit by filling your prescription at Walmart or Kroger (or their affiliates) to receive the medication at a lower copay amount.

If you go to an out-of-network pharmacy, you’ll be required to pay the out-of-network coinsurance amount, which will cost you more out-of-pocket.

Walmart (and its affiliates Sam’s Club and Neighborhood Market) 

Kroger (and its affiliates Bakers Pharmacy, City Market Pharmacy, Dillon Pharmacy, Fred Meyer Pharmacy, Frys Food and Drug, Gerbes Pharmacy, Harris Teeter, Jay C Food Stores, King Soopers Pharmacy, Mariano's, Pay Less Pharmacy, Pick N Save, Metro Market, QFC Pharmacy, Ralphs Pharmacy, and Smiths Pharmacy)

Walgreens (and affiliates including Duane Reade)

Community Pharmacy Prescription Network (CPRxN) - Access the Pharmacy Directory for the current list of pharmacies who participate in the Community Pharmacy Prescription Network (CPRxN).

 

Prime Therapeutics Pharmacy Medications on the Specialty Products List must be purchased through this specialty pharmacy vendor.

Learn more  

 

 

To locate network pharmacies near you, visit or contact: