As our pharmacy benefits manager, CVS Caremark reviews and processes your claims when you purchase prescription medications. Members covered by our pharmacy benefit may fill prescriptions at any of the more than 63,000 CVS Caremark–participating pharmacies, which include retail chain stores, independent pharmacies, and designated specialty pharmacies, in addition to CVS/pharmacy locations. The CVS Caremark mail service is available for members who take maintenance medications. Maintenance medications are those you refill each month for conditions such as diabetes, high blood pressure, and asthma.
If you are currently on a medication, be sure you have enough on hand to last until your new coverage takes effect.
When You’re Ready to Fill a New Prescription, Follow These 3 Easy Steps:
- Confirm that your medication is on our list of covered drugs:
If your medication is not listed, speak to your provider about alternatives that are covered.
- For coverage dates starting 01/01/2019, please refer to the following links:
- Massachusetts Individual and Small Group 3-tier Drug List: PDF
- Massachusetts Individual and Small Group 4-tier Drug List: PDF
- Rhode Island Individual and Small Group 4-tier Drug List: PDF
- Massachusetts Large Group 3-tier Formulary: PDF
- Massachusetts Large Group 4-tier Formulary: PDF
- Rhode Island Large Group 3-tier Formulary: PDF
- Rhode Island Large Group 4-tier Formulary: PDF
- Check whether any of the following pharmacy management programs apply to your medication:
If any of these programs apply, follow the applicable recommendations outlined in step 3, below.
- PA: Prior authorization
- NC: Non-covered
- STPA: Step therapy
- QL: Quantity limitation
- SP: Designated specialty pharmacy
- Follow these appropriate steps for any applicable pharmacy management programs:
PA (prior authorization) or NC (non-covered): Contact the provider who has written your prescription. If your provider believes that a drug with a PA or NC is necessary for your treatment, your provider may submit a request for coverage. We will cover the medication if it meets our medical necessity coverage guidelines.