2026 Pharmacy Transition Information
Please note that a transition of this magnitude will involve a learning curve as we adjust to a new benefit partner. If you recall, Penn State had similar issues when moving from Highmark in 2018 to CVS Caremark and Aetna; then again when moving from CVS Caremark and Aetna in 2023 back to Highmark. Regardless of the pharmacy benefit partner, whether Highmark or CVS Caremark, all have experienced increases to the allowed amounts for medications.
Below are helpful reminders regarding the 2026 plan year so that you get the best value from your pharmacy benefits. Also keep in mind that CVS Caremark sent letters to all members including those affected by formulary or specialty medication changes.
Lion Advantage – Remember the deductible starts over on January 1 each year – all covered medications (and medical services) are subject to the deductible before being covered – members still receive the benefit of the “allowed amount” versus full retail cost.
Weis Pharmacy – Is in-network with CVS Caremark. CVS Caremark reached out to Weis Markets with education regarding their in-network status.
Lion Traditional Condition Care Program – Diabetic supplies are covered in full on this plan. Early in January we learned that CVS Caremark had an indicator in the pharmacy system that required the pharmacy input a diagnosis code that prevented the supplies from processing with a $0 cost share. This has been corrected and anyone who paid out of pocket for their supplies will be reimbursed.
Prior Authorization from Highmark – Approved prior authorizations carried over to CVS Caremark in two separate files – one in October 2025 and one early in January 2026. This means that some prior authorizations that were approved by Highmark later in 2025 may not have reached CVS Caremark until January 2026. If you were in the process of having Highmark approve a prior authorization request, but that process was not completed by December 31, 2025, your doctor will now need to ensure that the prior authorization request is submitted to CVS Caremark for review. Anyone still experiencing concerns or difficulties with an approved prior authorization should call CVS Caremark at 1 (833) 298-7175.
Specialty Medications and Prudent Rx – For the Lion Traditional program - for some specialty medications, CVS Caremark uses Prudent Rx (similar to Highmark’s Copay Armor program) that leverages manufacturer coupons. There is some coordination that needs to occur so anyone having concerns or difficulties should call CVS Caremark at 1 (833) 298-7175.
Humira – For those members with an approved prior authorization for Humira, the prior authorization has been transferred to CVS Specialty but requires that the medication be filled with an approved biosimilar. There is some coordination that needs to occur so anyone having concerns or difficulties should call CVS Caremark at 1 (833) 298-7175.
NEW benefit – Retail 90 – Scripts written for 84- to 90-day supply will be available for direct pick-up from an in-network Retail 90 pharmacy location, without going through a true mail order pharmacy (medications mailed to your home from CVS Mail Order), but still for the mail order coinsurance amount. Please remind your doctor to prescribe the appropriate days’ supply. This new benefit is especially convenient for those whose medications must be refrigerated. Specialty medications can also be picked up at a Retail 90 location – just stipulate when ordering that you want it sent to a Retail 90 pharmacy; CVS, Giant Eagle, Giant, Medicine Shoppe, Rite Aid, Walmart, Sav-On, Costco, Boalsburg Apothecary, Moshannon Valley, and many other independent pharmacies. Please keep in mind that while these pharmacies are in-network for the Retail 90 program, they may choose to fill or not fill certain medications as a 90-day supply based on their business needs. Is it always in your best interest to check with an in-network Retail 90 location before having your script sent in.
Any questions on formulary medications, finding a network pharmacy, checking the cost of a specific medication or how your plan works, please contact CVS Caremark at 1 (833) 298-7175.
Zepbound and Wegovy Cost Summary (2025–2026)
Costs for Zepbound and Wegovy have remained largely stable between the 2025 and 2026 plan years. Pricing differences between Highmark and CVS are minimal for 30-day supplies (approximately $1), while 90-day supplies are slightly lower through CVS, with savings ranging from $14 to $26 per fill.
For those members taking Zepbound or Wegovy who have experienced an increase in cost for 2026, please note the information below related to the changes between 2025 and 2026 for decreased manufacturer coupon amounts.
Zepbound
- Average cost for a 1-month supply is approximately $1,035–$1,037.
- Average cost for a 3-month supply is approximately $3,080–$3,115, with mail-order options slightly lower in some cases.
- Manufacturer coupons
- In 2025, the manufacturer offered discounts of $150 for a 1-month supply or $450 for a 3-month supply.
- In 2026, the manufacturer offered discounts of $100 for a 1-month supply or $300 for a 3-month supply.
Wegovy
- Average cost for a 1-month supply is approximately $1,285–$1,287.
- Average cost for a 3-month supply ranges from approximately $3,835–$3,860.
- Manufacturer coupons
- In 2025, the manufacturer provided discounts of $250 for a 1-month supply or $750 for a 3-month supply.
- In 2026, the manufacturer provided discounts of $100 for a 1-month supply or $300 for a 3-month supply.
The above average costs for 1-month or 3-month supply are the allowed costs for CVS Caremark and Highmark. You can check the specific amount for CVS Caremark using the cost estimator links below based on your medical plan enrollment.
- Lion Traditional: members will be responsible for 50% coinsurance of the allowed cost for a 1-month supply, or a 20% coinsurance of the allowed cost for a 3-month supply, before manufacturer coupons have been applied, until they have reached their prescription out-of-pocket maximum.
- Lion Advantage: members will be responsible for 100% of the allowed cost until your plan deductible is met, thereafter a 20% coinsurance of the allowed cost will apply for a 1-month or 3-month supply, before manufacturer coupons have been applied.
2026 Pharmacy
Penn State continually reviews employee benefits to provide faculty and staff with the highest quality and most affordable healthcare possible. While Highmark Blue Shield will remain the University’s third-party administrator for medical services, CVS Caremark will replace Express Scripts and Accredo as the University’s pharmacy provider.
- Highmark and CVS Caremark will coordinate benefits to ensure accuracy of any plan deductibles that include both medical and prescription claims
- CVS Caremark is the largest pharmacy benefit manager (PBM) in the United States with a national network of over 60,000 in-network pharmacies, including many chain and independent pharmacies.
- You should not need a new pharmacy in most cases.
- If your current pharmacy is participating with CVS Caremark, you will simply need to present your new card, for your prescription to be processed correctly under your updated prescription plan.
- If your drug formulary status is changing between Express Scripts / Accredo as compared to CVS Caremark or CVS Specialty, CVS Caremark will be mailing letters to impacted member homes the week of November 24, 2025.
- Welcome Kits will be mailed out mid- to late-December to employees including information regarding CVS Caremark and ID card(s) for every covered member.
- Prior Authorization Information
- Current PAs with Highmark will be honored with CVS Caremark.
- Refill Information
- Your existing prescriptions at retail pharmacies and/or University Health Services can be refilled after January 1, 2026; just present your new CVS Caremark ID card.
- Refills through Express Scripts by mail and Accredo Specialty will be transferred to CVS Caremark or CVS Specialty; available for refill upon normal refill date on or after January 1, 2026.
- Highmark/Express Scripts and CVS Caremark formulary listings do vary:
- CVS Basic Control Formulary
- CVS Advanced Control Specialty Formulary
- PrudentRx Specialty Drug Formulary
- PrudentRx Member Program - Please read for details regarding how PrudentRx works.
You are able to use the following tools to estimate the cost of your current medications. If you have any questions when reviewing these details, please contact CVS Caremark at the Penn State dedication phone number 1 (833) 298-7175.
Faculty, Staff, and Postdoctoral Appointees
- Lion Traditional CVS Cost Estimator
- Lion Advantage HSA or Flex CVS Cost Estimator (THIS LINK PROVIDES COINSURANCE COSTS AFTER DEDUCTIBLE HAS BEEN MET)
Technical Service Employees
- Lion Traditional CVS Cost Estimator
- Lion Advantage HSA or Flex CVS Cost Estimator (THIS LINK PROVIDES COINSURANCE COSTS AFTER DEDUCTIBLE HAS BEEN MET)
CVS Caremark Enhancements
Beginning with our change to CVS Caremark for January 1, there will also be several enhanced programs that we will be taking advantage of.
Retail 90
CVS Retail 90 allows covered members to get a 90-day supply of maintenance medications at a participating CVS Pharmacy, rather than a 30-day supply. This program is for medications you take regularly for chronic conditions, like high blood pressure or diabetes, and it offers cost savings and convenience by reducing the number of trips to the pharmacy. To use it, you need a 90-day prescription from your doctor, which you can then fill at a participating in-network pharmacy.
Scripts written for 83 days or less can be filled as Retail 90 at an in-network pharmacy will result in the normal retail pharmacy coinsurance. Scripts written for 84 days up to 90 days can be filled as Retail 90 at an in-network pharmacy will result in the mail order pharmacy coinsurance.
Specialty Starter Fill
CVS Specialty Starter Fill is part of a program designed to help new or non-adherent patients start specialty medications more effectively. It provides a smaller initial supply, typically two weeks, to monitor adherence and manage potentially complex specialty drugs with frequent side effects or dose changes.
For a defined list of specialty drugs, new-to-therapy users and members who have not met adherence requirements receive a two-week supply initially. The CVS Caremark system will track member utilization of the medication. To receive a full month's supply of medication, members must accumulate a 60-day supply of the medication within a rolling six-month timeframe. Those who do not meet the 60-day requirement are considered new-to-therapy users and remain limited to the two-week supply.
The program reduces potential waste of high-cost specialty medications with high rates of side effects and frequent changes. It helps manage member adherence and care, which can lead to better outcomes while also aiming to provide cost savings for members.
ScriptSync
CVS ScriptSync is a program that coordinates your multiple eligible maintenance prescriptions so you can pick them up at the same time, usually in one monthly visit to the pharmacy. By aligning your prescription fill schedules, ScriptSync aims to improve medication adherence and convenience by making it easier for patients to get all their necessary medications together.
You can enroll by talking to a CVS pharmacist, and once set up, prescriptions are refilled on a recurring schedule, with notifications when they are ready. The pharmacist will work with you to identify your eligible maintenance medications and choose a single "synchronization date". For medications that will run out before the synchronization date, the pharmacist will provide "short fills" or additional days' supply to ensure all prescriptions are ready on that day.
Once enrolled, your prescriptions are put on a 30-day, recurring schedule, and your eligible refills are coordinated for your chosen pick-up date. You'll receive a call or text message just before your ScriptSync pickup date, letting you know your order is ready.
Caremark Cost Saver
CVS Caremark Cost Saver is a program that automatically applies the lowest available drug price to many common, non-specialty generic medications, non-rebate eligible generic medications. Members don't need to do anything extra; their CVS Caremark ID card is all that is needed at the pharmacy to receive the benefit of the lower price at the point of sale.
All out-of-pocket costs paid through the Cost Saver program are applied to the member's plan deductible and out-of-pocket maximum. There's no need for the member to take any action, such as using a separate discount card or searching for prices online.
Rx Savings Plus for Non-Covered Drugs (PENCD)
The CVS Rx Savings Plus for Non-Covered Drugs program is a discount program offered by CVS Caremark to provide savings on medications that are not covered by an individual's primary insurance plan. The savings are integrated directly into a member's existing pharmacy benefit plan. To receive a discount, a member simply needs to present their CVS Caremark benefit card and a prescription at a participating pharmacy.
Unlike many independent discount card programs, this program allows for critical safety measures, such as drug utilization reviews, by capturing member utilization data from each claim.
2026 Lion Traditional Prescription Coinsurance
| Pharmacy Type | Coinsurance Amount |
|---|---|
| Retail Pharmacy (31-day supply or less) | 50% generic 50% preferred brand 70% non-preferred brand |
| ACA Preventive Drugs | 0% |
| Preventive Drugs (lower coinsurance) | 10% generic 20% preferred brand 40% non-preferred brand |
| Specialty Drugs | Faculty, Staff, Postdoctoral Appointee 50% preferred brand, $100 maximum 70% non-preferred brand, $200 maximum Technical Service 50% preferred brand, $50 maximum 70% non-preferred brand, $100 maximum |
| Retail 90 Pharmacy (83-day supply or less) | 50% generic 50% preferred brand 70% non-preferred brand |
| Retail 90 Pharmacy (84-day supply up to 90-day supply) | 20% generic 20% preferred brand 70% non-preferred brand |
| CVS Mail Order | 20% generic 20% preferred brand 70% non-preferred brand |
2026 Lion Advantage
| Pharmacy Type | Coinsurance Amount |
|---|---|
| Retail Pharmacy (31-day supply or less) | 10% generic 20% preferred brand 40% non-preferred brand |
| ACA Preventive Drugs | 0% |
| Preventive Drugs (no deductible, coinsurance only) | 10% generic 20% preferred brand 40% non-preferred brand |
| Specialty Drugs | 20% preferred brand, $65 minimum 40% non-preferred brand, $100 minimum |
| Retail 90 Pharmacy (83-day supply or less) | 10% generic 20% preferred brand 40% non-preferred brand |
| Retail 90 Pharmacy (84-day supply up to 90-day supply) | 10% generic 20% preferred brand 40% non-preferred brand |
| CVS Mail Order | 10% generic 20% preferred brand 40% non-preferred brand |
Register at Caremark.com or the CVS Health mobile app
When you register at Caremark.com, you’ll get access to tools and resources. There are three easy ways to register:
- Go to Caremark.com, click the Register button and follow the instructions to sign up
- Download the CVS Caremark® mobile app from Google Play or the App Store to register your account
- Call the number on the back of your member ID card and a representative will get you started with a personalized registration email or text
Register to:
- Refill your prescription
- Check the status of your order
- Review your coverage and track annual spending
- Locate network pharmacies near you
- Check medication costs and find opportunities to save money
- Log into Caremark.com from your desktop to access these additional features: manage your profile information, including shipping addresses, payment methods, and notifications
The CVS Health® app provides access to everything you need, all in one place. Now, it’s faster and easier than ever to keep track of retail pharmacy, mail order and specialty prescriptions, securely access plan benefits, and enjoy savings right from your phone with the upgraded mobile app.
- Manage prescriptions: View orders, locate in-network pharmacies, and request refill delivery or pickup using a scannable barcode** in the app. You
can even check the status on a prior authorization request. - Find helpful tools & info: Check and compare drug costs across in-network pharmacies to find possible savings. You can view your ID card and track current
deductible and copay amounts, too. - Get answers & support: Need help with a complex condition or medication guidance? CVS Caremark is here for you and your family. And if someone helps manage your health, you can grant them access right in the app.