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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 — English (PDF) | Spanish (PDF).

 

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.

 

Formulary and updates

 

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.

 

OTC benefit Overview (PDF)

 

2024 OTC Product Catalogue and Guide — English (PDF) | Spanish (PDF)

Frequently Asked OTC Questions (FAQ) (PDF)

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.

 

Find a pharmacy near me

 

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   

Medicamentos especializados

Medicamentos especializados

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:

 

  • Cáncer
  • Hemofilia
  • Immune deficiency
  • Esclerosis múltiple
  • Artritis reumatoide

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)

  • Envío a su domicilio, el consultorio del médico o cualquier otro lugar que usted elija.

  • 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)

 

Specialty drug list (PDF)

Here’s a list of preferred specialty pharmacies that you can get your specialty medications from.

 

Accuserv Pharmacy

Phone: 1-724-978-0110

Fax: 877-526-8823

 

Banks Apothecary

Phone: 1-800-927-6703

Fax: 215-357-2129


BioMatrix Specialty Pharmacy

Phone: 610-545-6040

Fax: 610-545-6030
 

Caremark Specialty Pharmacy

Address: 800 Biermann Center, Suite B, Mount Prospect, IL 60056

Phone: 1-800-447-4791

Fax: 1-800-323-2445


Caremark Specialty Pharmacy

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

 

Giant Eagle Pharmacy

Address: 20160 Center Ridge Road, Suite 201, Rocky River, OH 44116

Phone: 1-440-356-3287

Fax: 1-877-645-4142
  

Giant Eagle Pharmacy

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

 

Value Specialty Pharmacy

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.

 

Medication recalls

 

Contáctenos

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.

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