When it comes to your health, we are with you every step of the way. Our top-tier services and resources are available to help you make the most informed decisions for you and your family. As a pharmacy benefit manager or PBM, CapitalRx’s role is to oversee your prescription benefit plan. They work closely with employers and health plans to offer the right balance of drug access and cost savings. The plan setup or features of your pharmacy benefit can impact where you can fill your prescriptions and your cost at the pharmacy.

A pharmacy network is a group of pharmacies that we are contracted with to provide medication at a specific price. For a pharmacy to be part of our network, they must meet specific standards and go through a detailed review process. Each pharmacy in the network is reviewed on a re-occurring basis to ensure they consistently meet business standards. Different types of pharmacies can be included in a network. They are typically organized into channels called retail, mail order or specialty pharmacy. This part of your pharmacy benefit can affect your cost and drug access.

A copay or coinsurance is a form of cost sharing between you and your employer or health plan. Copays are flat costs your pharmacy plan setup may have to determine what you pay for medications. Coinsurance also defines what you pay for medications, but it is calculated as a percentage rather than a flat cost

A deductible is another form of cost sharing but defines the amount you must pay before your plan will pay for covered medications. A deductible can be combined with your medical costs and will count towards one total amount. If a plan setup has a separate prescription deductible, only drug costs will count towards this amount.

A maximum out-of-pocket (MOOP) is the most you will pay for your covered medications each year. This typically includes your deductible, coinsurance, and copay amounts. How or what costs apply to your MOOP is specific to each plan setup.

Contact Information:

855.599.1013
cap-rx.com

Prescription Resources

Capital Rx Welcome Booklet
Capital Rx Welcome Flyer
ACA Medication List
Preventative Medication
Mail Order Information
Specialty Medication Information

Ready to enroll?

Visit bswift to elect your benefits during the annual open enrollment period or if you experience a qualifying event.