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Pharmacy Benefits

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All of our health plans include full prescription drug benefits. 

  • The health plan you choose determines your out-of-pocket prescription costs (copay, coinsurance, deductible and out-of-pocket maximum).
  • How much you pay will depend on three things:
    • The drug tier – if you choose a generic, preferred brand, non-preferred brand or specialty drug;
    • The day supply you receive – 30-day (or <30) supply or a 90-day (>31) supply; and
    • Where you fill your prescription – at a retail, Retail-90 or mail order pharmacy.

Click here for a 2021 benefit comparison, including pharmacy, for state and higher education.

Click here for a 2022 benefit comparison, including pharmacy, for state and higher education.

Click here for a 2021 benefit comparison, including pharmacy, for local education and local government.

Click here for a 2022 benefit comparison, including pharmacy, for local education and local government.

Click here for the CVS Caremark preferred drug list. (This list is updated each January, April, July and October.)

Click here for a list of medications that require prior authorization for medical necessity.

Click here for a list of medications with utilization management requirements (such as prior authorization, step therapy or quantity limits).

CVS Caremark
877.522.TNRX (8679)

For 2022 coverage, all enrolled members will receive new pharmacy ID cards. Employees new to coverage, or who change or transfer plans, will receive new ID cards.

Members can request additional ID cards by contacting the carrier or by using the carrier’s mobile app.

Prescription drug tiers

Tier One - Generic drugs: You’ll pay the lowest amount. A generic medicine is FDA approved and equal to the brand name product in safety, effectiveness, quality and performance.

Tier Two - Preferred brand drugs: You’ll pay a higher amount. Many popular and highly used preferred brands are included on the preferred drug list, or PDL.

Tier Three - Non-preferred brand drugs: You’ll pay the highest amount. These belong to the most expensive group of drugs. These drugs are not included on the PDL.

Specialty drug tier: In the PPOs, 10% coinsurance applies with a member minimum ($50, unless the drug cost is under $50, then you would pay the full cost of the drug) and a maximum ($150) out-of-pocket. Members enrolled in a CDHP pay coinsurance for specialty drugs and are responsible for the full insurance-negotiated cost of the drug until you reach your plan’s deductible. 

Did you know?

CVS Caremark has information to help you with your prescriptions.

  • Learn more by calling 877.522.8679 or go to to find a pharmacy and compare drug costs by plan. You’ll also find the preferred drug list (formulary), member handbook and FAQs.
  • Register on the CVS Caremark website and get details about your drug costs, download the mobile app and more!
  • Taking your medication as directed helps you stay healthier. Check out some tips to keep you on track.

Find a CVS Caremark network pharmacy

You can find a 30-day or 90-day network pharmacy through the CVS Caremark website at You can also call CVS Caremark customer service at 877.522.8679 to find a network pharmacy near you.

How to save on your prescriptions

Medications you fill on an ongoing basis could cost you less by filling them at a participating Retail-90 pharmacy or CVS Caremark Mail Service. You make fewer trips to the pharmacy and only need to make one payment every three months. There are several ways to get a 90-day supply of the drugs you take regularly for ongoing conditions. You can conveniently fill those prescriptions either through CVS mail order or at any participating Retail-90 pharmacy nationwide. Find a list of the nationwide Retail-90 pharmacies by going to for details.

  • Maintenance drugs
    • There are lower out-of-pocket costs on a large group of maintenance drugs. The maintenance tier allows you to get a 90-day supply of these drugs from a Retail-90 or mail order pharmacy at a reduced cost. The maintenance drug list includes certain medications for high blood pressure, high cholesterol, coronary artery disease, congestive heart failure, depression, asthma/chronic obstructive pulmonary disease (COPD), statins for high cholesterol, depression and diabetes (oral medications, insulins, needles, test strips and lancets). Some osteoporosis medications have been added to the maintenance drug tier list. Does not apply to any osteoporosis medications considered as a specialty medication (some examples include: Forteo, Prolia, Reclast and Evenity) 
  • Copay installment program
    • Members can spread the cost of 90-day mail order prescriptions that are filled through the CVS Caremark mail order pharmacy over a three-month period — at no additional cost. You may enroll online at, register and log in, or by calling CVS Caremark customer care at 877. 522.8679. This benefit is only for 90-day mail order prescriptions provided by CVS Caremark mail order. This does not apply to specialty medications.

Flu and pneumococcal vaccine coverage

Additional pharmacy benefits and savings

Diabetic supplies

In 2022, the only covered meters, test strips and supplies are those from OneTouch and Accu-Chek. The only covered needles and syringes are BD brand products. Members will have lower copays using supplies from these preferred brands. Enrolled members with diabetes may be eligible for a new OneTouch or Accu-Chek blood glucose meter at no charge from the manufacturer. For more information on how to obtain a free blood glucose meter, call 877.418.4746.

Certain low-dose statins

Eligible members can receive these medications in-network at zero cost share. These medications are primarily used to treat high cholesterol. No high-dose or brand statins are included. Applies to members ages 40 through 75 years old.

Weight management

Anti-obesity medication is available for members who meet prior authorization requirements as determined by the pharmacy benefits manager. This gives members a less costly, non-surgical option for losing weight. Go to to look for covered medications. They are found under “Antiobesity” on the preferred drug list.

Certain medications used to treat opioid dependency

Members won’t have to pay for some of these medications.  

Tobacco cessation products

Members who want to stop using tobacco can get free tobacco quit aids.

The following quit aids are FREE under the pharmacy benefit:

  • Chantix
  • Bupropion (Generic Zyban)
  • Over-the-counter generic nicotine replacement products, including gum, patches and lozenges
  • Nicotrol oral and nasal inhalers

Members may receive up to two, 12-week courses of treatment per calendar year (up to 168 days of treatment) with no lifetime maximum. A licensed clinician is required to write a prescription to get any tobacco cessation products at no cost, including over-the-counter aids. Simply present your prescription and your CVS Caremark card at the pharmacy counter (not at the check-out registers) to fill at $0 copay. The plan only covers generic over-the-counter tobacco cessation products.

Click here for the Member Handbook.

Click here for Frequently Asked Questions (FAQs)

Members have the right to appeal a denial made by CVS Caremark. There are three levels of appeal available:

  • First Level Appeal — If the member's prescription requires prior authorization, and the request is denied because it does not meet their plan's approved criteria for use of the medication, the member may choose to appeal the denial. The member or their authorized representative may request that CVS Caremark re-review the request along with any additional clinical information that the member's physician provides. If this appeal request is not approved, the member will receive a letter explaining the decision and providing information about how to request a second level internal appeal from CVS Caremark.
  • Second Level Appeal — If the member's first level appeal is denied, the member or their authorized representative may choose to request that CVS Caremark review the case and determine whether the drug is medically necessary for the member's treatment. CVS Caremark will review the case and any additional clinical information provided by the member's physician to make this determination. If this appeal is not approved, the member will receive a letter explaining the decision and providing information about how to request an external review of their case from an independent review organization, or IRO.
  • External Review — If the member's second level internal appeal is denied, the member or their authorized representative may choose to request that an IRO review the case and make a final determination. The IRO will communicate their decision to the member. This decision will be final and binding on the member, the plan and CVS Caremark.