It makes sense that your clients’ pharmacy plan should work closely with their medical plan. But carve-out vendors would have them believe otherwise.
Our agreements with our PBM (Optum Rx) include clinical program terms and conditions, with many clinical programs provided at no cost. Plus, we have extensive audit rights to protect our clients. We issue competitive RFPs every three years or more frequently as market conditions change.
The reality is that, with more than one million members, our size gives us the power to negotiate aggressive discounts and maintain a low pharmacy trend. We offer nominal dispensing fees and waive administrative fees—and we’re fully transparent with our pricing and rebates.
We can customize your client’s pharmacy program based on their specific needs with:
- Flexible networks
- Multiple formularies
- Tiered copayment plans
- Mail-order refills, and
- Preferred-product strategies
Our Pharmacy & Therapeutics Committee includes local doctors familiar with practice patterns in our market. Carve outs, on the other hand, have to work within generic national guidelines.
Our targeted pharmacy program promotes close monitoring of medication compliance. The program is focused around chronic conditions, using specialty pharmacy care teams to help ensure adherence to complex—and expensive—medication schedules for better outcomes.
We also practice active management of specialty drugs. We take a proactive role to secure price protections, reassess preferred drug strategies, and negotiate rebates for all new drug launches.
Use the links below to confirm whether or not a specific drug is on our list of covered drugs.
For coverage dates starting 01/01/2023, please refer to the following lists.
For coverage dates starting 01/01/2022, please refer to the following lists.
Please note, CVS Caremark was our pharmacy benefit manager through 12/31/2022.
Individual and small group formularies
Large group formularies