QL
By Alphabet
Select a letter to view drugs starting with that letter
Legend
-
T0Tier 0
-
T1Tier 1
-
T2Tier 2
-
T3Tier 3
-
T4Tier 4
-
HCRHealth Care Reform
-
NCNot Covered
† Denotes brand name drug, otherwise generic drug
BRAND NAMES
generic names
Caterpillar Closed Formulary
Welcome to the Caterpillar Drug Formulary
This formulary applies to active Employees and certain Retirees that are covered by the prescription drug
benefit provisions of the Caterpillar Inc. Employee Health, Life and Disability Benefit Program, the Caterpillar Inc.
Retiree Benefit Program, the Caterpillar Inc. Group Insurance Plan A, and the Caterpillar Inc. Group Insurance
Plan B.
What is a Formulary?
A formulary is a list of medications that are covered by the plan. The formulary is reviewed quarterly for possible additions and deletions. New generics for a covered brand name medication may be covered between quarterly updates based on plan approval and availability. Use of generic medication is required when generic is available.
The formulary is developed and maintained by a team of Physicians and Pharmacists based on product safety, efficacy, and clinical integrity. If a medication or product that has been prescribed for you or your covered dependents is not on the formulary, it is not a covered benefit. You will pay 100% of the full retail cost. You may wish to speak to your doctor for an alternative option.
How to Search For Drugs
Plan Design
Co-pay / Co-insurance Tiers
This is the amount you will pay for medications covered under the plan after meeting your deductible (if applicable). Amounts are based on a 30-day supply unless otherwise noted.
| Drug Tier | In-Network* Walmart, Kroger, Walgreens, CPRxN | Out-of-Network (All other Pharmacies) | Mail Order/ Home Delivery*** (90-day Supply) |
|---|---|---|---|
| Tier 0 | $0 | $25 | $0 |
| Tier 1 | $5 Walmart/ Kroger $10 Walgreens/ CPRxN | $25 | $30 |
| Tier 2 | 20% co-insurance Min $35 | Max $70 | 30% co-insurance Min $60 | Max $130 | 20% co-insurance Min $105 | Max $210 |
| Tier 3 | 50% co-insurance Min $85 | Max $135 | 50% co-insurance Min $160 | Max $260 | 50% co-insurance Min $255 | Max $405 |
| Tier 4 includes specialty** | 50% co-insurance Min $110 | Max $210 | 50% co-insurance Min $160 | Max $260 | Not offered |
*Includes affiliates of Walmart, Kroger, and Walgreens
** Network Pharmacy for Specialty Medications is Magellan Rx Pharmacy
***AllianceRx Walgreens Prime (formerly Walgreens Mail Order)
Preventive (PR)
If you are enrolled in a Consumer-Directed Health Plan Option (CDHP), you may be required to pay the full cost of your medication until you reach your deductible. Please review the Consumer-Directed Health Plan Preventive Drug List on benefits.cat.com for those drugs that bypass the deductible. These drugs also can be identified by the label of ‘PR’ within the formulary list.
Diabetic Supplies & Insulins
The following over-the-counter (OTC) diabetic supplies and Insulins are covered under the prescription drug benefit with a valid prescription from your provider.
| Product Description | Tier | Limits & Restrictions |
|---|---|---|
| Insulin Syringes | 1 | PR-Preventive Medication |
| Lancets | 1 | PR-Preventive Medication QPD-Quantity Per Day |
| Glucose Meters | ||
| Accu-chek | 2 | PR-Preventive Medication QL-Quantity Limit |
| One Touch | 2 | PR-Preventive Medication QL-Quantity Limit |
| All Other Brands | 3 | PR-Preventive Medication QL-Quantity Limit |
| Glucose Test Strips | ||
| Accu-chek | 1 | PR-Preventive Medication QPD-Quantity Per Day |
| One Touch | 1 | PR-Preventive Medication QPD-Quantity Per Day |
| All Other Brands | 3 | PR-Preventive Medication QPD-Quantity Per Day |
| Insulins | ||
| HUMULIN 70-30 VIALS HUMULIN N VIALS HUMULIN R VIALS NOVOLIN N VIALS NOVOLIN R VIALS NOVOLIN 70-30 VIALS | 0 | PR-Preventive Medication |
Health Care Reform (HCR)
The list includes preventive care medications covered in accordance with the Patient Protection and Affordable Care Act (ACA), as modified by the Healthcare and Education Reconciliation Act of 2010. Certain preventive care medications are covered at 100% by the plan if you use an In-Network Pharmacy. If you use an Out-of-Network Pharmacy, you will be subject to the applicable co-pay or co-insurance. These medications are labeled as ‘HCR’ on this formulary listing. For additional information on preventive care medications covered by the plan, visit: healthcare.gov/center/regulations/prevention.html or uspreventiveservicestaskforce.org
Additional Information
Please refer to your summary plan description (SPD) provided at catatwork.cat.com
If you have questions about your prescription drug coverage, you can also call Magellan Rx Customer Service toll-free at 1-877-228-7909 24 hours a day, 7 days a week.
The information regarding alternatives is not intended and should not be construed, in any way, as medical advice, opinion, diagnosis or as advice about the treatment of any specific medical condition. You should consult with your physician regarding your particular health needs and whether any of the alternative treatments are right for you. In the event that the content of this document or any representations made by any person regarding the plan conflict with or are inconsistent with the provisions of the plan document, the provisions of the plan document are controlling. To the fullest extent permitted by law, Caterpillar reserves the right to amend, modify, suspend, replace or terminate any of its plans, policies or programs, in whole or in part, at any time and for any reason, by appropriate company action.