Prescription Drugs
Capital Rx Pharmacy
All of the Sysco-sponsored national medical plans have the same prescription coverage through Capital Rx.
Capital Rx’s broad network of pharmacies includes CVS Pharmacy as well as hundreds of non-CVS locations such as Costco, Sam’s Club, Target, Walgreens, Walmart, and most major grocery chain pharmacies. You can use any in-network retail pharmacy to fill a 90-day supply of your medication or home delivery through Costco mail-order services.Â
Capital Rx covers certain medications, supplements, and products at no cost.
How You Pay for Prescriptions
The amount you pay out of pocket for your medications depends on the Sysco-sponsored medical plan you’re enrolled in. All plans offer ways to save on your prescriptions.
HSA Plan
In the HSA plan, you pay the full cost of all non-preventive prescriptions until you meet your deductible. Then the plan begins paying a portion of the costs.
Basic, PPO, and National HMO Plans
In the Basic, PPO, and National HMO plans, the plan pays a portion of your prescription drug costs, whether you have met the medical deductible or not.
Brand Name vs. Generic
As a plan participant, if you receive a brand-name drug in place of a generic in either of the situations below, the plan will only cover the cost of the generic drug, requiring you to pay the cost difference between the brand-name and the generic drug:
- The doctor prescribes a brand-name drug and indicates that the patient (plan participant) should not be switched to the generic.
- The patient (plan participant) tells the pharmacist that they are only to have the brand-name drug and that they do not want to be switched to a generic.
What You Pay for Care
In-Network
Basic* | HSA** | PPO* | National HMO* | |
|---|---|---|---|---|
Pharmacy-Filled Generic 30-day supply | $12 copay | $12 copay after deductible | $12 copay | $12 copay |
Pharmacy-Filled Formulary 30-day supply | 30% coinsurance ($40 min./$80 max.) | 30% coinsurance after deductible ($40 min./$80 max.) | 30% coinsurance ($40 min./$80 max.) | 30% coinsurance ($40 min./$80 max.) |
Pharmacy-Filled Non-Formulary 30-day supply | 50% coinsurance ($80 min./$160 max.) | 50% coinsurance after deductible ($80 min./$160 max.) | 50% coinsurance ($80 min./$160 max.) | 50% coinsurance ($80 min./$160 max.) |
Value Drugs*** | $0 | $0 | $0 | $0 |
Mail-Order Generic 90-day supply | $30 copay | $30 copay after deductible | $30 copay | $30 copay |
Mail-Order Formulary 90-day supply | 30% coinsurance ($80 min./$160 max.) | 30% coinsurance after deductible ($80 min./$160 max.) | 30% coinsurance ($80 min./$160 max.) | 30% coinsurance ($80 min./$160 max.) |
Mail-Order Non-Formulary 90-day supply | 50% coinsurance ($180 min./$350 max.) | 50% coinsurance  after deductible ($180 min./$350 max.) | 50% coinsurance ($180 min./$350 max.) | 50% coinsurance ($180 min./$350 max.) |
* You do not have to meet your deductible (if applicable) before receiving a benefit for prescription drugs if you use a network pharmacy. ** You meet your deductible, then pay any applicable copays or coinsurance. *** Select list of preferred generic and brand OTC drugs available for a reduced copay. | ||||
Out-of-Network
Basic | HSA | PPO | National HMO | |
|---|---|---|---|---|
Pharmacy-Filled Generic 30-day supply | You pay the full cost | You pay the full cost | You pay the full cost | You pay the full cost |
Pharmacy-Filled Formulary 30-day supply | You pay the full cost | You pay the full cost | You pay the full cost | You pay the full cost |
Pharmacy-Filled Non-Formulary 30-day supply | You pay the full cost | You pay the full cost | You pay the full cost | You pay the full cost |
Value Drugs* | $0 | $0 | $0 | $0 |
Mail-Order Generic 90-day supply | You pay the full cost | You pay the full cost | You pay the full cost | You pay the full cost |
Mail-Order Formulary 90-day supply | You pay the full cost | You pay the full cost | You pay the full cost | You pay the full cost |
Mail-Order Non-Formulary 90-day supply | You pay the full cost | You pay the full cost | You pay the full cost | You pay the full cost |
* Select list of preferred generic and brand OTC drugs available for a reduced copay. | ||||
Home Delivery and
Mail Order
Save time and money! Capital Rx partners with Costco to deliver your prescriptions to your home—at no cost to you.
‍Note: If you fill a 30-day supply for maintenance medications, or at any other pharmacy, your medications won’t be covered, and you’ll have to pay the entire cost.
Download the App
The Capital Rx mobile app makes managing your prescriptions simple, with tools to help you find nearby pharmacies, compare drug prices, review your claims history, check your plan’s formulary, and track prior authorization status—all in one place.
I Want To...
Register for a Capital Rx Account
Go to cap-rx.com, and select Register Now. You’ll need:
- Your new prescription ID number, which can be found on your Capital Rx ID card or your Social Security number
- Your date of birth
- Your email address
- Check prescription costs and coverage
- Find in-network pharmacies
- Access mail-order and home delivery options
Find a Pharmacy and Fill a Prescription
There are several ways to fill your prescriptions, depending on your needs. To find in-network pharmacies, access the Capital Rx look-up tool.
Request a Refill
You can easily request a prescription refill by contacting your pharmacy directly. If you don’t have any refills remaining, the pharmacy can help by reaching out to your provider on your behalf.
Review the Formulary and/or Find a Generic Drug
You can review the full Capital Rx Formulary here.
