57 Prescription Drug Coverage — CVS Caremark The Plan will pay fo r certain drugs that are prescribed by your physician or Allied Health Professional, after you pay the applicable copayment or coinsurance . If you, your Spouse, or Eligible Dependent Child get a covered prescription filled or refilled at a participating ph armacy that has an agreement with the pharmacy benefit manager ( CVS Caremark ), the Plan pays the total cost of the prescription minus your copayment or coinsurance . You will be supplied with a CVS Caremark Prescription Drug Card, which you must present at the participating pharmacy when you get a prescription filled. The Plan does not cover prescriptions filled or refilled at non - participating pharmacies. CVS Caremark Specialty Pharmacy Services include a program called ACSF, which means Advanced Control Sp ecialty Formulary . With ACSF, in addition to the required medical necessity review, Specialty Medications will also be reviewed to determine whether a preferred alternative exists that should be tried first. If an alternative is available, it will be discussed with your physician or Allied Health Professional and the script changed. This is part of the prior authorization process wh ich will be transparent to you. The prescription copayment or coinsurance shown in the Schedule of Benefits is your out - of - pocket expense for each covered prescription that is filled. Under the terms of the Plan, different copayment or coinsurance levels apply for generic drugs, preferred brand name drugs, and non - preferred brand name drugs. If you use generic drugs whenever possible you will incur the lowest out - of - pocket expense to you and to the Plan. To determine the applicable copayment or coinsurance for any particular drug, you can go to the CVS Caremark website at www.caremark.co m , and register to obtain specific benefit information. Or, you can call the CVS Caremark Customer Care line at 800 - 282 - 8503. Note: Prescription drug copayments or coinsurance are not reimbursable under this benefit or an y other provision of the Plan. The Plan limits the amount of a drug you can get at any one time under the prescription drug benefit. You have the following options to obtain your prescription: • Mail Order will provide up to a 90 - day supply of covered maintenance medication. • CVS Retail P harmacies will provide up to a 90 - day supply of covered maintenance medication. • Other Participating Retail Pharmacies will provide up to a 34 - day supply of any covered medication. • CVS S pecialty will provide up to a 34 - day supply of specialty medication, or other quantity as appropriate based on dosing, therapy, and handling limitations. Out - of - Pocket Limit T he Plan includes an out - of - pocket limit on the prescription drug program administered by CVS Caremark . The out - of - pocket limit is shown in the Schedule of Benefits. When a participant’s cumulative out - of - pocket expenses in a calendar year reach the applicable out - of - pocket limit shown in the Schedule of Benefits, prescription drug copayments o r coinsurance will be waived for that participant for the rest of the applicable calendar year. When covered participants in your family have accumulated individual out - of - pocket amounts in the applicable calendar year that, when combined, equals or excee ds the family out - of - pocket limit shown in the Schedule of Benefits, copayments or coinsurance for prescription drugs will be waived for all covered participants in your family for the remaining months of the applicable calendar year.