What you need to know
When you enroll in the Solstice Medical Plan, you automatically have the benefit of prescription drug coverage. If you are enrolled in the Cigna or Horizon network, your coverage is through CVS Caremark. In the Kaiser network, participants have prescription drug coverage through Kaiser, and the details are different.
How the prescription drug plan works
You have access to a network of retail pharmacies and a mail-order drug program pharmacy.
Note: You will need to log in to your CVS account to review.
Solstice helps you save money on medications you take every day (such as diabetes, high blood pressure, or asthma medication).
You pay nothing for generic preventive medicines.
Effective March 1, 2025, brand preventive medicines (including diabetic medicines) will bypass the deductible. Solstice will pay 80% of the cost, and you will pay the remaining 20% for 30-day ($200 max) and 90-day ($400 max) prescriptions. Learn more.
All other prescription drug costs apply toward the medical plan annual deductible and out-of-pocket maximum.
See prescription drug costs for annual base pay over $50K and annual base pay under $50K.
Until you meet the annual deductible, you pay the full cost of all other prescriptions.
The actual amount can vary by pharmacy.
After you meet the annual deductible, Solstice pays 80% of the cost for each covered prescription drug if you use a network pharmacy.
You pay the remaining 20%. However, there is a limit for how much you pay per prescription to limit your financial exposure for high-cost prescription drugs. The cap is $200 for each retail prescription and $400 for a 90-day supply through the mail or a CVS Pharmacy.
Once you meet the plan’s out-of-pocket maximum, Solstice pays the full cost of covered prescription drugs.
Specialty drugs
For specialty medications, you must use the CVS Specialty pharmacy. These drugs can be mailed to your home or doctor’s office or local CVS. If you fill specialty prescriptions at a pharmacy other than CVS Specialty, you will have to pay the entire cost out of pocket. Cigna Pathwell Specialty® helps make specialty medications more accessible and easier to manage.
Pay $0 with PrudentRx enrollment. PrudentRx allows participating members to fill covered specialty medications that are on your plan's PrudentRx program drug list for $0 out of pocket once your deductible is met. If you are not enrolled or have questions, call PrudentRx at 800-578-4403.
