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Prescription Drug Plan
http://www.caremark.com
(active employees only)
(866) 260-4646
Specialty Pharmacy Web Site:
https://www.cvsspecialty.com/wps/portal/specialty
CVS Caremark Prescription Plan Highlights
Copayments for generic, preferred and non-preferred brand prescription drugs, are per the following schedule:
|
Prescription Drug Class |
30-Day Supply – Retail |
90-Day Mail Order |
|---|---|---|
|
Generics |
$13 |
$21 |
|
Preferred brand |
$25 |
$45 |
|
Non-preferred brand |
$40 |
$65 |
- Maintenance Choice Program – plan participants who take maintenance medications have the choice to purchase their 90-day supply from the mail order program or from a CVS/Pharmacy store and pay the same mail order copayment.
- Mandatory Generics – required when available as well as using the mandatory specialty pharmacy program or specialty prescription drugs. Recognizing that there are times when a patient cannot take a generic, FCPS has established a Formulary Exception Process. This process requires a member to try a number of generic drugs, under the direction of their physician. Should those generic drugs not be appropriate for the member’s condition, an exception for a brand drug/non-formulary drug can be approved for limited time period. If you believe this applies, you or your physician may contact CVS Customer Service to begin the Formulary Exception Process. Customer Service: 1-866-260-4646
- Diabetic Meter Program – plan participants with diabetes may qualify for a free blood glucose meter when diabetic testing supplies are ordered through the mail order program.
CVS uses a formulary list of generics and preferred medications to keep your prescription copays at the lowest cost possible. Recognizing that there are times when a patient cannot take a generic, FCPS has established a Formulary Exception Process. This process requires a member take a number of generic drugs, under the direction of their physician. Should those generic drugs not be appropriate for the member’s condition, an exception for a brand drug/non-formulary drug can be approved for limited time period. If you believe this applies, you or your physician may contact CVS Customer Service to begin the Formulary Exception Process. Customer Service: 1-866-260-4646
Frequently Asked Questions
There are often multiple medicines available to treat the same condition – either a generic medicine, brand-name medicine or both. These options have shown to be effective and safe, and they may even help you save money on your prescriptions. Our pharmacy staff has determined that your medicine has these types of options available. You and your doctor can determine the best covered option for you.
The U.S. Food and Drug Administration (FDA) has approved more than 10,000 generic medicine options for brand-name medicines, so there is likely to be one available to help you obtain a lower-cost, effective treatment. Generic medications are available for common conditions such as high cholesterol, blood pressure, allergies, asthma, migraines, stomach acid, osteoporosis and others.
Yes. In fact, many generics can cost up to 80 percent less than their brand-name counterparts. You can check your drug coverage and costs now to see how much you can save by choosing a generic medicine instead of a brand-name medicine. Generic medicines are less expensive because the original patent has expired, and other manufacturers can apply to the FDA to sell the generic version. With no investment costs and more competition among the generic manufacturers, the price of generics is kept down.
Research shows that individuals on average can save 30 to 80 percent by using generics. Your savings will vary based on your plan and/or drug prescribed. Source: Generic Pharmaceutical Association.
If your doctor thinks there is a clinical reason why one of these covered options won’t work for you, your doctor can call us toll-free at 1-800-294-5979 to request prior approval for your current medicine(s). Please remember that approvals are granted only in a limited number of cases, so it is best to talk to your doctor about choosing a covered option.
The drug will pay at a tier 3 non-preferred copay/coinsurance. If it is a multi-source brand drug, the “Member Pays the Difference” penalty may also apply.
- Prior Authorization - Some medications require Prior Authorization (PA). If this applies to a medication that you have been prescribed, CVS will notify your physician of this requirement when your prescription is received. The prescribing physician will be asked to provide additional medical information to approve the prescription for you. Once this has been provided and evaluated by CVS, the prescription will be filled or your physician will receive specific information as to why the medication was denied. You will be mailed an explanation as to the denial of the medication which will include information on the appeal process.
Prior Authorization Frequently Asked Questions
CVS Caremark is committed to helping you get the most effective medicines at the best price. Our pharmacy staff continually reviews medicines, products and prices for your plan sponsor. As part of this effort, some medicines on your drug list require prior approval by your doctor and our clinical staff.
If your current medicine does not receive approval by your doctor and our clinical staff, you will pay the full price if you continue using it. Since approvals are granted only in a limited number of cases, you will want to talk to your doctor soon about choosing a covered option.
Yes, the member will receive a letter via mail and the doctor via fax.
Yes. All appeals can be mailed or faxed to the following:
CVS Caremark Prescription Claim Appeals MC109
P.O. Box 52071
Phoenix, AZ 85072-2071
Fax 1-866-443-1172
Please review the additional information on generics and other prescription resources in the links below.