Pharmacy benefits carriers

Aetna plans include prescription drug coverage through CVS Caremark. Kaiser Permanente has its own exclusive pharmacy benefits.

Teammates can fill their prescriptions at CVS and other participating pharmacies included in the Aetna Extended Day Supply Network.

Prescription drug tiers

Certain preventive medications are covered at 100% with no deductible required. In addition to preventive medications there are four benefit tiers for prescription drugs: 

• Tier 1 – Generally contains generic drugs that are cost effective alternatives to brand name drugs
• Tier 2 – Generally contains preferred brand name drugs that are chosen for their clinical value and cost effectiveness
• Tier 3 – Generally contains non-preferred brand drugs
• Tier 4 –Specialty drugs, such as gene therapies and biotechnological medications, and consists of the highest-cost prescription medications 

Prescription drugs

What you pay

You’ll pay either a copay or a percentage of a drug’s cost at an in-network pharmacy, depending on your plan and the drug tier. There is no out-of-network coverage.

For Tier 4 specialty drugs, Aetna's Prudent Rx can help reduce your costs. If your specialty drug is on the Prudent Rx list, you're eligible for the program and will contacted by mail to enroll or you can call 800-578-4403. 

*Kaiser $2,500 HDHP plan coverage is the same as the Aetna $2,500 HDHP coverage (PrudentRx doesn’t apply).

Weight loss medication coverage

Starting Jan. 1, 2025, GLP-1 medications for weight loss will continue to be covered under Truist’s medical options, but only for those enrolled in Virta’s Sustainable Weight Loss program.

• Coverage for GLP-1 medications for weight loss prescribed outside of Virta won’t be covered under Truist’s medical options.
  
• This applies only to weight loss prescriptions. GLP-1 medications for diabetes will be covered as before; Virta enrollment isn’t required.
• If you were prescribed a GLP-1 medication for weight loss before 2025, you’re now required to enroll in Virta.

How it works

Current prescriptions

1. Before the end of the year, you’ll get an invitation to join Virta.
2. You’ll get more information about the program and the process for refills.

New prescriptions

1. After you get a new prescription, you’ll be notified that the medication is available only through Virta.
2. You’ll be directed to register with Virta.
3. You’ll meet with a Virta provider, who will guide you to the right weight loss path for you.

Visit Virta to learn more about the paths, get your questions answered, and check your eligibility.

Scripta: Prescription drugs savings

Teammates have access to Scripta, a benefit that helps you save money.

• Your prescriptions at the lowest cost: Scripta searches for the best prices to help you and your doctor choose the medications best for you.
• Monthly savings reports: Scripta creates monthly, personalized savings reports that list lower-priced drug options and savings strategies. The suggested alternatives treat the same medical conditions as the medications you’re already taking. 
• A helpful tool to discuss with your doctor: Doctors usually don’t know how much your medications cost. Scripta gives you and your doctor information to help decide which drugs are best for your health and your wallet.