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Pharmacy benefits
Need medication? Your pharmacy benefits include a wide range of prescription and over-the-counter (OTC) medications to keep you as healthy as you can be.
Medications your plan covers
Prescription medications
We cover the prescription medications on the [formulary/preferred drug list (PDL)]. These medications need to be medically necessary. This means you need them to manage a health condition. You may or may not have small copays.
You can check the [formulary/PDL] [PDF] . Or check the PDL online. If your medication isn’t on this list, ask your provider to:
Prescribe a similar one that’s on the [formulary/PDL]
Get prior authorization (PA) for coverage
Need PA? Just ask your provider to complete PA. Or they can call ${provider_services_phone} (TTY: 711).
Still not sure if we cover your medication? Just call ${member_services_phone}. When you call, have a list of your prescription medications ready. We can check them for you.
Other drug lists
You can also see the list of medications we cover for [specific conditions].
Understand your medication
Be sure to tell your providers about all the medications you take. This includes over-the counter medications, vitamins and supplements. Understand what your medication is for and how to take it. Check out these medication tips. [Or find answers to your questions in our pharmacy FAQs.]
OTC medications
You can get coverage for some OTC medications on the [formulary/PDL] [(PDF)] when you:
- Meet any added requirements (for some medications)
- Get a prescription from your provider
- Fill your OTC prescription at a pharmacy in our network
Still not sure if we cover your medication? Just call ${member_services_phone}. When you call, have a list of your OTC medications ready. We can check them for you.
$25 for OTC products
[As well as standard coverage for some OTC products on the PDL, we added another OTC benefit for you. Enjoy [$25] per month (per household) toward some OTC medications and supplies. We’ll mail them directly to you. Just have your member ID number ready when you place your order:
Online: Just sign in with your member ID and password. Or create a new account if you’re a first-time visitor.
By phone: You can call OTC Health Solutions at 1-888-628-2770 Monday through Friday, 8 AM to 4 PM.
Get medications and refills
If you need medication, your provider will write you a prescription for one on the [formulary/PDL]. You’ll want to:
- Ask your provider to make sure the medication is on the [formulary/PDL]
- Take your prescription to a pharmacy in our network
- Show your plan member ID card at the pharmacy
Need refills? Your medication label notes how many refills you have. Call your pharmacy to place a refill order well before you run out of medication. If your prescription is out of refills, check with your provider at least five days before you run out of medication. They may want to see you before adding refills.
Fill your prescriptions
In person
You can fill your prescriptions at any pharmacy in our network. We can’t cover medications that you fill at other pharmacies.
By mail
Do you take medication regularly for a chronic (long-term) condition? If yes, you may be able to get medication by mail. Read on to learn more about starting mail service.
Get started with mail service
You can sign up for mail service:
Online
Log in to your Member Portal. Go to “Tasks” and then “Pharmacy Services.” Go to Caremark.com by clicking on the “CVS” link. Then, choose “start mail service” to print the mail-order form.
By phone
Just call CVS Caremark® at 1-855-271-6603 (TTY: 1-800-231-4403) You can call 24 hours a day, 7 days a week. If you say it’s okay, they’ll call your provider to get a prescription.
With an order form
Ask your provider to write a prescription for a 90-day supply with up to one year of refills. Then, fill out a mail service order form — English (PDF) | Spanish (PDF).
Send the form, along with your prescription, to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110
Specialty medications
Some conditions that need specialty medications include:
- Cancer
- Hemophilia
- Immune deficiency
- Multiple sclerosis
- Rheumatoid arthritis
Do you have a prescription for a specialty medication? If yes, you can fill it at any pharmacy in our network. Not all pharmacies carry these medications. So you may need to find a specialty pharmacy.
Your provider may need to get PA for some medications.
Medication recalls
Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332.
Pharmacy access and rules
The [formulary/PDL] [(PDF)] is up to date with covered medicines. Remember that some medications need PA before you can get them.
What is the Pharmacy Lock-in program?
This program helps to prevent potential abuse or misuse of medical or pharmacy benefits. Members choose one in-network pharmacy to fill prescriptions and stick with it.
What happens if my pharmacy doesn’t have the medicine I need?
You’ll be able to get a 72-hour supply of medicine from a different pharmacy. You can also do this in an emergency.
What if I don’t want to use only one pharmacy?
You can file an appeal. To get started, just call ${member_services_phone}. Or use this name of appeal form (PDF). You have [60 days] to file an appeal from the date on your letter about the Lock-in program.
Contact us
Questions? Just call Member Services at ${member_services_phone}. We’re here for you ${member_services_hours}.
Questions? Just call Member Services at ${member_services_phone}. We’re here for you ${member_services_hours}.