Another group or vendor provides the info on the next page. If you don’t want to leave our site, choose the “X” in the upper right corner to close this message. Or choose “Go on to next website” to move forward.
Contact us
Questions? Just call [Provider Relations/Provider Services] at [provider services phone].
Questions? Just call [Provider Relations/Provider Services] at [provider services phone].
Covered medications
Prescription medications
We cover the prescription medications on the [preferred drug list (PDL)/formulary] [at no extra cost to members/with small copays (usually $[X] or less)]. If your patient needs medication, you’ll want to check the list for covered medications, step therapy requirements, quantity limits and updates. You can download the list or check it online.
If a medication isn’t on the [PDL/formulary], you can:
- Prescribe a similar one that’s on the list
- Get prior authorization (PA) for coverage
Still not sure if we cover a specific medication? Just call [provider services phone]. We can check it for you.
You can also see the list of medications we cover for [diabetes supplies or other topic].
[Diabetes supplies or other topic list name (PDF)]
Members can get coverage for OTC medications on the [PDL/formulary (PDF)] when they:
- Meet any added requirements (for some medications)
- Get a prescription from their provider
- Fill their OTC prescription at a pharmacy in our network
Not sure what’s covered? Just call us at [provider services phone]. Be sure to have the member’s list of medications ready. We can check to see if they’re on the list.
Members can get $25 per month toward some OTC medications and supplies.
Specialty medications
If you prescribe a specialty medication, members can fill it at any pharmacy in our network. Not all pharmacies carry these medications, so members may need to find a specialty pharmacy. Some conditions that need specialty medications include:
- Cancer
- Hemophilia
- Immune deficiency
- Multiple sclerosis
- Rheumatoid arthritis
You’ll want to get PA for these medications. Fax the PA form to [provider services fax/PA-specific plan fax]. Or you can call [provider services phone] to ask for PA. You can also include any medical records that may help with the review of your request.
More pharmacy info
Learn about everything from [step therapy to prior authorization (PA)].
If a member needs prior authorization (PA) for a medication, you can fill out a pharmacy PA form on their behalf. Or you can call us at [provider services phone].
When members need medication, they’ll:
- Ask you to make sure the medication is on the [PDL/formulary]
- Take their prescription to a pharmacy in our network
- Show their plan member ID card at the pharmacy
Remind members to check with you at least five days before running out of medication. They understand that you may want to see them before prescribing refills.
Members can fill prescriptions at any pharmacy in our network. We can’t cover medications they fill at other pharmacies.
When members take maintenance medication for an ongoing health condition, they can get it by mail. We work with CVS Caremark® to provide this service at no extra cost. Each order is checked for safety. And members can speak with a pharmacist anytime on the phone.
To get started, members will need their:
- Plan member ID card
- Mailing address, including ZIP code
- Provider’s first and last name and phone number
- List of allergies and other health conditions
- Original prescription from their provider (if they have it)
Mail service makes it easy
Members and providers can call CVS Caremark at 1-855-271-6603 (TTY: 711), 24 hours a day, 7 days a week. They’ll explain which medications can be filled with CVS Caremark Mail Service Pharmacy. CVS Caremark will also contact you for a prescription and mail the member’s medication. Members can sign up for mail service:
Online
Members can go to the Member Portal and sign in or register (for new users). Then, they’ll choose: Tasks, Pharmacy services, CVS and Start mail service.
With an order form
Members will ask you to write a prescription for a 90-day supply with up to one year of refills. Then, they can fill out a:
Mail service order form – English (PDF).
Mail service order form – Spanish (PDF).
Or we can mail them a form. They just need to call us at [member services phone].
Members can send the form, along with their prescription, to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110
By phone
Members can also call CVS Caremark at 1-855-271-6603 (TTY: 711). They can call 24 hours a day, 7 days a week. If they agree, CVS Caremark will call you to get a prescription.
The step therapy program requires certain first-line drugs, such as generic drugs or brand-name drugs, to be prescribed before approval of specific, second-line drugs. The [PDL/formulary] identifies these drugs as “STEP.”
Certain drugs on the [PDL/formulary] have quantity limits. The [PDL/formulary] identifies these drugs with the letters “QLL.” Quantity limits are based on:
- FDA-approved dosing levels
- Nationally established, recognized guidelines related to each condition
Need to ask for an override for step therapy or a quantity limit? Just fax the pharmacy PA form to [provider services fax}/PA-specific fax]. Or you can call [provider services phone] to ask for PA. You can also include any supporting medical records that may help with the review of your request.
Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332. Or visit the drug recalls page on the FDA website.
Legal notices
Aetna and CVS Caremark® are part of the CVS Health® family of companies.