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CVS/Caremark

 

Pharmacies

CVS/Caremark has over 62,000 participating pharmacies for members to choose from. To view a list of participating pharmacies, click here.


Mail Order

Members can utilize mail order services to fill prescriptions which save both the member and the company money. Members utilizing mail order services enjoy benefits like:

  • Reduced copays.
  • A 90-day supply of medication at one time.
  • Convenient home prescription delivery, including free standard shipping.
  • 24-hour, toll-free hotline to speak with a registered pharmacist.
  • Convenient internet and refill by-phone services to order prescription refills any time, day or night.

 

For more information, please view the informational brochure about the CVS/Caremark mail order program.


Drug Pricing

CVS/Caremark provides two alternatives for categorizing brand name prescription drugs. Each alternative provides a large breadth of prescription drug coverage for members while offering clients the ability to better manage member/plan cost share for Rx benefits. The two alternatives are:

  • Preferred Drug List – In this model, generics are considered the first line of prescribing and the list provides the preferred brand name medicines that are both clinically appropriate and cost effective for the plan. Brands not appearing on the list are in the highest copay tier.  
  • Select Drug List – In this model, generics are also considered the first line of prescribing. In contrast to the Preferred Drug List, this list offers a wider selection of drugs in the middle copay tier, providing a more cost effective benefit to member vs. the plan.

 

Brand Dispensing Policies

Clients utilizing the CVS/Caremark network may select from the following three policies regarding brand drug dispensing:

  • Most Restrictive for Member – the member will pay the difference between the maximum allowable coverage price for the generic and the plan average wholesale price for the brand (in addition to the calculated copay) whether the member or physician is requesting the brand.  
  • Less Restrictive for Member - the member will pay the difference between the maximum allowable coverage price for the generic and plan average wholesale price for the brand (in addition to the calculated copay) only when the member requests brand. The client sponsor will pay the difference if the doctor requires the brand.
  • No Restrictions for Member – Client sponsor will pay the difference no matter who requests the brand. If the physician or member requests the brand name drug, the member will only pay the brand copay.
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