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Medications your plan covers
Medications your plan covers
Prescription medications
We cover the prescription medications on the formulary. 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. If you’re unsure, you can check your member handbook:
You can check the downloadable formulary (PDF). Or check it using our online search tool. If your medication isn’t on this list, ask your provider to:
Prescribe a similar one that’s on the formulary
Get prior authorization (PA) for coverage
Need PA? Just ask your provider to complete PA. Or they can call Provider Relations at 1-866-638-1232 (TTY: 711).
Want more info about the formulary, including updates and our search tool? Just visit our formulary and updates page.
Still not sure if we cover your medication? Just call 1-800-822-2447 (TTY: 711). When you call, have a list of your prescription medications ready. We can check them for you.
Understand your medication
Be sure to tell your providers about all the medications you take. This includes OTC medications, vitamins and supplements. Understand what your medication is for and how to take it. Check out these medication tips.
OTC medications
You can get coverage for some OTC medications on the formulary 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 1-800-822-2447 (TTY: 711). When you call, have a list of your OTC medications ready. We can check them for you.
$30 for OTC products
As well as standard coverage for some OTC products on the formulary, we added another OTC benefit for you. Enjoy $30 per month (per member) 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
Get medications and refills
If you need medication, your provider will write you a prescription for one on the formulary. You’ll want to:
- Ask your provider to make sure the medication is on the formulary
- 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:
Mail service order form – English (PDF)
Mail service order form – Spanish (PDF)
Send the form, along with your prescription, to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110
Specialty medications
Specialty medications
What are specialty medications? Usually, you can't get these type of medications at a local retail pharmacy. These types of medications may be injected, infused or taken by mouth. They often need special storage and handling. And they need to be delivered quickly.
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.
You can enjoy many helpful services, including:
- Secure delivery of your medication at no cost
(usually within 48 hours of confirming your order) - Delivery to your home, doctor’s office or any other place you choose
- Package tracking for timely delivery
- Training on how to use or self-inject your medication
- Injection supplies at no cost (examples: needles, syringes, alcohol swabs,
adhesive bandages and containers for safely throwing away needles)
Here’s a list of preferred specialty pharmacies that you can get your specialty medications from.
Phone: 1-724-978-0110
Fax: 877-526-8823
Phone: 1-800-927-6703
Fax: 215-357-2129
Phone: 610-545-6040
Fax: 610-545-6030
Address: 800 Biermann Center, Suite B, Mount Prospect, IL 60056
Phone: 1-800-447-4791
Fax: 1-800-323-2445
Address: 180 Passaic Avenue, Fairfield, NJ 07004
Phone: 1-800-237-2767 or 1-877-408-9742
Fax: 1-800-323-2445
CVS Specialty
Address: 105 Mall Boulevard, Monroeville, PA 15146
Phone: 1-800-238-7828
Fax: 1-800-323-2445
Einstein at Center One Pharmacy
Phone: 1-877-218-4499
Fax: 215-827-1934
Address: 20160 Center Ridge Road, Suite 201, Rocky River, OH 44116
Phone: 1-440-356-3287
Fax: 1-877-645-4142
Address: 2500 Lovi Road, Freedom, PA 15042
Phone: 1-888-792-1552
Fax: 1-877-645-4142
Sunray Drugs Specialty
Phone: 1-215-471-4000
Fax: 215-471-4001
Phone: 1-855-265-8008
Fax: 844-812-6227
Medication recalls
Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332.
Contact us
Questions? Just call Member Services at 1-800-822-2447 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.