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Pharmacy

Choose the pharmacy coverage for you

Prescription drug coverage is provided through CVS Caremark. You are automatically enrolled when you enroll in any of the Boston Children’s Medical Plans.

Coverage Overview

Category

Blue Basic
HMO

Blue Plus
HMO

Blue Premium
PPO

Blue Essentials HDHP + HSA

Boston Children’s On-Site Pharmacy Mail Order
(90-day supply)

$10 Tier 1

$60 Tier 2

$135 Tier 3

10% coinsurance after deductible

Boston Children’s On-Site Pharmacy (30-day supply)

$5 Tier 1

$25 Tier 2

$45 Tier3

10% coinsurance after deductible

Retail/Mail Order
(90-day supply)

$25 Tier 1

$75 Tier 2

$150 Tier 3

20% coinsurance after deductible

Retail
(30-day supply)

$10 Tier 1

$30 Tier 2

$50 Tier 3

20% coinsurance after deductible

Mail Order Program

If you use long-term medication or are on a maintenance prescription that needs to be refilled regularly, you must refill for three months at a time. You can do this either at a CVS, through Caremark’s (retail) mail order pharmacy, or at the on-site pharmacy.

PillarRx

Copay Assistance Program through PillarRx

For certain qualifying high-cost medications, Boston Children’s partners with PillarRx who assist members covered under the hospital’s pharmacy plan to obtain copay assistance from drug manufacturers to reduce out-of-pocket expenses.

View this FAQ for details.

CVS Weight Management Program

Boston Children’s covers GLP-1 medications under CVS Caremark’s formulary. As part of this covered benefit, the CVS Weight Management program will partner with you to help you reach your goals using various tools to address overall health and wellbeing.

New prescribers, watch your mail for registration and details to participate so you may receive the covered rate for your GLP-1. View this FAQ for details.

Use the Boston Children’s Hospital On-Site Pharmacy

The Boston Children’s Hospital Pharmacy is available to fill your prescriptions — including adult prescriptions for maintenance and acute medications. The pharmacy is conveniently located at 283 Longwood Avenue, Boston, and open from 8 a.m. to 11 p.m. seven days a week. You can receive free home delivery if you live in New England or New York!

Read your pharmacy FAQ document for more information and answers to your questions.