Pharmacy Benefits
All Partners for Health medical plans include pharmacy benefits, managed by CVS Caremark. Visit tn.gov/partnersforhealth/health-options/health to learn about our health insurance plans.
Contact CVS Caremark
Phone: 877.522.TNRX (8679) | 24/7
Website: info.caremark.com/stateoftn
In 2026, pharmacy costs will increase mainly due to weight loss and specialty medications. Here are the 2026 pharmacy cost-sharing changes:
- Members will pay 25% coinsurance for medications prescribed for weight loss for all plans.
- Members will pay 30% coinsurance for in-network specialty medications for all plans.
- A separate maximum out-of-pocket amount will be added for specialty drugs members obtain through the pharmacy benefit. The amount varies based on employee tier and plan selected.
As a reminder, specialty drugs and medications prescribed for weight loss are limited to a 30-day supply.
Frequently Asked Questions
To print or order an ID card:
- Log onto www.caremark.com (or register if have not already done so)
- Click on “Plan & Benefits”
- Click on the submenu “Print Member ID Card”
- Choose either
a. the red button “Print Member ID Card” or
b. “Request a new Member ID card” and fill in the information needed then click “Submit”
You can review the Performance Drug List – Standard Control for Clients with Advanced Control Specialty Formulary® for State of Tennessee and the Advanced Control Standard Formulary®. Refer to both document links to access the non-specialty drug list and the specialty drug list. These lists are updated each January, April, July and October.
Some drugs can have serious side effects when not used appropriately. Your doctor will need to get prior authorization for some non-specialty drugs and most specialty drugs before your prescription benefits will cover them.
Contact your doctor and ask him/her to call CVS Caremark directly at (800) 294.5979 (providers only) to request prior authorization for your prescription.
How our pharmacy benefits work
State and Higher Education Employees and Retirees:
Review the 2026 health options comparison chart to see pharmacy copays, coinsurance, deductible and out-of-pocket maximum.
Review the 2025 health options comparison chart to see pharmacy copays, coinsurance, deductible and out-of-pocket maximum.
Local Education and Local Government Employees and Retirees:
Review the 2026 health options comparison chart to see pharmacy copays, coinsurance, deductible and out-of-pocket maximum.
Review the 2025 health options comparison chart to see pharmacy copays, coinsurance, deductible and out-of-pocket maximum.
1. *The drug tier
Your choice of a generic, preferred brand, non-preferred brand or specialty drug will help determine price.
2. The day supply you receive
A 30-day (or less than a 30-day supply) or 90-day (or greater than a 31-day supply) supply.
3. **Where you fill your prescription.
You can fill at a retail, Retail-90, mail order or specialty pharmacy.
*Prescription Drug Tiers
Tier 1 generic drugs: You’ll pay the lowest amount. A generic medicine is approved by the Food and Drug Administration and equal to the brand name product in safety, effectiveness, quality and performance.
Tier 2 preferred brand drugs: You’ll pay a higher amount. Many popular and highly used brands are included on the Performance Drug List – Standard Control for Clients with Advanced Control Specialty Formulary®.
Tier 3 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 Performance Drug List – Standard Control for Clients with Advanced Control Specialty Formulary®.
Medications Prescribed for Obesity: In 2026, members in all plans will pay 25% coinsurance for medications prescribed for weight loss.
Specialty drugs: For a 30-day supply, members in all plans will pay 30% coinsurance for in-network specialty medications. There will also be a separate out-of-pocket maximum for specialty drugs members obtain through the pharmacy benefit. The amount varies based on the employee tier and plan selected. Go to the Publications webpage and then go to Insurance Comparison Charts for more information.
Members enrolled in a consumer-driven health plan pay coinsurance for specialty drugs and are responsible for the full insurance-negotiated cost of the drug until you reach your plan’s deductible.
All medications that are classified as a specialty medication may only be filled in a 30-day supply and must be filled either through the CVS Specialty Pharmacy OR through one of the pharmacies in the state’s custom specialty pharmacy network.
** Find a CVS Caremark Network Pharmacy
You can find a 30-day or 90-day network pharmacy through the CVS Caremark website at info.caremark.com/stateoftn. You can also call CVS Caremark customer service at 877.522.8679 to find a network pharmacy near you.
Additional Pharmacy Benefits and Savings
Tobacco quit products
Members who want to stop using tobacco can get free Tobacco Quits Aids.
Vaccinations
Members may get a flu vaccine, pneumococcal vaccine and other vaccines at no cost by using a participating vaccine network pharmacy. To check which pharmacies are in-network for vaccinations, use the online Pharmacy Locator tool: info.caremark.com/stateoftn and select “Advanced Options.” For additional information about your Partners for Health coverage for vaccinations, visit the Health Options webpage.
Diabetic supplies
The only covered meters, test strips and supplies are those from Accu-Chek and True Metrix. Members will have a lower copay using supplies from these preferred brands.
Enrolled members with diabetes may be eligible for an Accu-Chek blood glucose meter at no charge from the manufacturer. For more information on how to get a free blood glucose meter, call 877.418.4746 or visit https://info.caremark.com/dig/managingdiabetes.
Medications available at no cost to eligible members
Certain medications under the Affordable Care Act, such as contraceptives and tobacco cessation products, are available at no cost to you. A full list of available medications is available online at the following link: NoCost_Preventive_List.pdf.
Maintenance drugs
You can save money by filling medications you take regularly in a 90-day supply instead of a 30-day supply. For the Premier PPO, Standard PPO and Limited PPO, examples of maintenance drugs include those for high blood pressure, coronary artery disease, congestive heart failure, diabetes (insulins, oral meds and other injectables, needles, test strips and lancets), depression, high cholesterol, asthma/chronic obstructive pulmonary disease (COPD) and some osteoporosis medications (specialty drugs are not included). The maintenance medication benefit allows members to receive a 90-day supply at a reduced copay, instead of paying three 30-day copays.
Members enrolled in the CDHP or Local CDHP have a similar benefit that utilizes this HDHP/HSA Preventive Drug list from CVS Caremark: https://www.caremark.com/portal/asset/preventive_dl.pdf, and your drug will bypass the plan's deductible, which means your plan will pay its share of your covered services starting at the beginning of the year. You can conveniently fill these prescriptions either through CVS Caremark® Mail Service Pharmacy or at any Retail-90 pharmacy nationwide.
What does Retail-90 pharmacy mean? A Retail-90 pharmacy is one that has agreed to lower costs for their medications and their dispensing fees for providing your medication. You will save money when you get a 90-day supply of your medications. You will make fewer trips to the pharmacy, and you’ll only need to make one payment every three months. If you choose to use the Retail-90 option, you have 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 Caremark Mail Service Pharmacy or at any Retail-90 pharmacy nationwide. To check which pharmacies are in-network for a 90-day supply, use the online Pharmacy Locator tool: info.caremark.com/stateoftn.
Need Help?
• Call 877.522.8679 or go to info.caremark.com/stateoftn.
• Register on the CVS Caremark website and get details about your drug costs, download the mobile app and more.
• Review the Member Handbook.
• Find answers to Frequently Asked Questions.
Pharmacy Benefits
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.
- External Review — If the member's second level internal appeal is denied, the member or their authorized representative may choose to request that an independent review organization review the case and make a final determination. The independent review organization will communicate their decision to the member. This decision will be final and binding on the member, the plan and CVS Caremark.