Pharmacy / Rx Coverage
Pharmacy Administrator – CapitalRx
EAB partners with CapitalRx as our pharmacy manager. Upon enrollment, you will receive a medical ID card from Aetna that will include Aetna information as well as CapitalRx information. To locate pharmacies, compare plan designs and price medications, please visit cap-rx.com.
Prescription Drug Coverage (Offered Through CapitalRx)
| Aetna Value CDHP Plan | Aetna Premium CDHP Plan | Aetna PPO Plan | ||||
|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Retail, 30-Day Supply | ||||||
| Generic | 0% after deductible | Not Covered | 20% after deductible | Not Covered | $15 Copay | Not Covered |
| Preferred Brand | $35 Copay | |||||
| Non-Preferred Brand | $70 Copay | |||||
| Specialty | 10% up to $200 max | |||||
| Retail, 90-day supply | ||||||
| Generic | 0% after deductible | Not Covered | 20% after deductible | Not Covered | $45 Copay | Not Covered |
| Preferred Brand | $105 Copay | |||||
| Non-Preferred Brand | $210 Copay | |||||
| Specialty | Not Covered | |||||
| Mail Order, 90-day supply | ||||||
| Generic | 0% after deductible | Not Covered | 20% after deductible | Not Covered | $30 Copay | Not Covered |
| Preferred Brand | $70 Copay | |||||
| Non-Preferred Brand | $140 Copay | |||||
| Specialty | 10% up to $200 max | |||||
Access CapitalRx
- Via app.cap-rx.com/login
-
Website Technical Support: 855-598-9679
Partnering with Capital Rx for Your Prescription Savings
Capital Rx offers innovative programs to help you manage your pharmacy benefits and reduce out-of-pocket costs. With Rx Smart Save and Non-Specialty Copay Assistance, you have tools designed to make prescriptions more affordable and convenient.
Rx Smart Save
Included with your pharmacy benefits, Rx Smart Save notifies you of clinically appropriate, lower-cost alternatives to your medications—helping you save money without compromising care.
Here’s how it works:
- Receive real-time alerts through the Capital Rx app or Member Portal when a lower-cost option is available.
- Review savings details and discuss alternatives with your doctor.
- Switch to the recommended medication and start saving immediately.
- To activate Rx Smart Save, download the Capital Rx app or visit cap-rx.com. Click here to learn more.
Copay Assistance Programs
If your medication has a high copay, you may qualify for a manufacturer copay assistance program. Ask your pharmacist about enrolling and provide your copay card information to the pharmacy for processing.
Rx Value-Non-Specialty Medications:
- These programs often reduce your cost to $0–$25 per fill.
Rx Cap-Specialty Medications:
- These programs often reduce your cost to $0–$50 per fill.
Without enrolling, you’ll pay the full copay amount. For questions, call the pharmacy number on your member ID card or visit cap-rx.com. Click here for information.
CapitalRx Dedicated Member Services
Phone: 855-598-9679
Website: www.cap-rx.com
Contact CapitalRx’s dedicated member services team for more information about your pharmacy benefits. They can help you with:
- Understanding your pharmacy benefits
- Researching claims
- Exploring Home Delivery service