Prescription drug coverage is included with both health plan options, but costs apply differently depending on which plan you choose. Vanderbilt partners with Capital Rx to provide our pharmacy coverage.
Overview
The Vanderbilt Health Plan includes a prescription drug benefit managed by Capital Rx. The prescription drug benefit is a multi-level formulary (i.e., list of covered drugs) with a recommended generic program.
Not all prescription drugs are covered by the Vanderbilt Health Plan. Some prescription drugs require prior authorization from Capital Rx before the prescription can be filled.
For questions regarding your prescription drug program, contact Capital Rx at www.capitalrx.com or call 1-833-599-0942.
For those enrolled in the Aetna Choice CDHP medical option, pharmacy costs can really add up as you must first reach your deductible before you are only responsible for 20% coinsurance. To help make preventive medications more accessible, we put in place a program that will allow preventive medications to bypass the deductible, thereby reducing the out-of-pocket cost for you and your covered family members. The medications that are eligible for this program are determined by Capital Rx and are subject to change each quarter as the formulary is updated. Please see the current list. Please note – the preventive drug list is a Capital Rx document and is not specific to the Vanderbilt University health plan. Any medications not covered by the Vanderbilt health plan are excluded from this program.
Formulary
The formulary is the list of drugs covered under the Vanderbilt Health Plan. Capital Rx updates the formulary each quarter, so medications could be added or removed throughout the year. You can access the current formulary by selecting Lookup Formulary in the menu on www.capitalrx.com .
If you need help, contact Capital Rx Customer Care at 1-833-599-0942
In-Network Pharmacies
The Vanderbilt Health Plan encourages faculty and staff to use in-network pharmacies, where you will get the best price for your prescriptions. The Capital Rx network includes major retailers such as Walgreens, Walmart, CVS, Sam’s Club, Costco, Publix and Kroger. For a complete list of in-network pharmacies in your area, visit www.capitalrx.com.
Mail Order Service for Long-Term Medication
Taking a 90-day maintenance medication? Consider having your medication delivered to your home by using a convenient mail order service through either Vanderbilt Mail Order Pharmacy or Costco.
With the Vanderbilt Mail Order Pharmacy, you can have a 90-day supply of your medication mailed to your home or you can pick it up at the Vanderbilt Pharmacy of your choice. For more information on how to start the mail order service, call the Vanderbilt Pharmacy mail order service at 615.875.0078 or visit the Vanderbilt Ambulatory Pharmacy Services webpage.
Capital Rx has partnered with Costco to fill your long-term medication. To start using this convenient service, you will need to create a profile with Costco. Please log on to capitalrx.com, scroll to the bottom of the home page and click on the forms and documents page link under Mail Order Pharmacy. Once there, select Plan Documents, and you’ll find helpful resources to sign up for Costco Mail Order services.
Specialty Drugs
Specialty drugs typically treat very serious diseases. They include biotechnologically produced or genetically engineered drugs that require special storage and handling. Coverage of specialty drugs is available only when filled through one of the Vanderbilt pharmacies. Please contact Capital Rx for more information about specialty drugs or see the Vanderbilt Specialty Pharmacy website
Mobile App
With Capital Rx's mobile app you can:
- Search for the lowest cost drug at surrounding pharmacies
- View your claims history
- Download a digital pharmacy card
- View which drugs are covered under you plan
- Track how much money you have paid toward your out-of-pocket expenses.
The mobile app features easy registration, simple navigation, and an innovative, user-friendly design to help you navigate your prescription benefits. Plus, you’ll gain access to all of the helpful information you need to make informed decisions about your prescriptions and health.
Money-Saving Tips
Drug Manufacturer's Coupons
The Vanderbilt Health Plan does not allow pharmacies to accept drug coupons for prescriptions because drug manufacturers promote their drugs with these coupons, which generally are more costly than a generic equivalent or a preferred drug for the health plan. While the patient’s use of a coupon will lower his/her own out-of-pocket cost, it lessens the patient’s responsibility as an active participant in the Vanderbilt Health Plan. Vanderbilt University pays the remaining cost whether or not coupons are used, yet pharmaceutical companies are trying to increase their utilization with these coupons, which drives up the cost to the health plan.
How to File a Claim
If you were unable to use your insurance to fill a prescription and paid out-of-pocket, you may file a claim directly with Capital Rx for processing under your prescription benefit and request reimbursement.
Visit the Capital Rx website and open the side menu in the top right corner of your screen. Under Forms and Documents, you’ll find a claim form under Direct Member Reimbursement. Completed forms along with your original receipt from the pharmacy can be mailed to:
Capital Rx, Inc.
Attn: Claims Department
9450 SW Gemini Dr., #87234
Beaverton, OR 97008
Frequently Asked Questions
Contact Information
- Website: www.capitalrx.com
- Customer Service: 1-833-599-0942