Pharmacy Benefits

All Partners for Health medical plans include pharmacy benefits, managed by CVS Caremark. Visit the Health webpage 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 are increasing mainly due to weight loss and specialty medications. Here are the 2026 pharmacy cost-sharing details:

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.

Specialty drugs and medications prescribed for weight loss are limited to a 30-day supply.

Frequently Asked Questions

How do I print or order an ID card?

To print or order an ID card:

Sign in to www.caremark.com (or register if you have not already done so).
Click on “Member ID Card.”
Click on the blue “Print Member ID Card” button to print your member ID card.
To request a replacement member ID card, click “Request a New Member ID card,” complete the member information form and click “Submit.”

Which medications are covered?

You can review the Tennessee formulary guidebook, titled Prescribing Guide – Standard Control for Clients with Advanced Control Specialty Formulary^®, to see which drugs are covered under your plan. The guidebook is updated quarterly—in January, April, July and October—to ensure you have the latest information.

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.

Need a prior authorization?

Prescriptions for certain medications require a prior authorization, also known as a coverage review, to ensure the medication is clinically appropriate and cost effective. The review uses both formulary and clinical guidelines to determine if the plan will pay for certain medications. Contact your doctor and ask him/her to call CVS Caremark directly at

800.294.5979 to request prior authorization for your prescription.

The following situations may require prior authorization for your prescription:

Your doctor prescribes medication not covered on the formulary
The prescribed medication is subject to age limits
You need additional quantities of certain medications, such as those used to treat migraines
The medication is only covered for certain conditions

If you are going on vacation and need an additional supply of your medication, please contact CVS Caremark customer service at 877.522.8679.

Can I appeal if my prior authorization is denied?

Members have the right to appeal a denial made by CVS Caremark. If the prior authorization is denied, you or your representative may appeal this decision by writing to:

CVS Caremark Appeals Department MC109
P.O. Box 52084
Phoenix, AZ 85072-2084

Please include:

Your name and member ID number
Doctor’s name and telephone number
Name of medication
Information relevant to your appeal

If you require an urgent review, please call CVS Caremark customer service at 877.522.8679 for instructions. Not all appeal requests are eligible for the urgent review process. Urgent appeals will be decided within 72 hours. If you choose to fill your prescription without prior authorization approval, you will be responsible for the full cost of the medication. You have a right to receive, upon written request and at no charge, information used to review your request.

Please note: You must submit an appeal within 180 calendar days after you receive the notice of a denial of a prior authorization.

There are three levels of appeal available:

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.
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.
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.

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.

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.

Additional Information about Copays and Coinsurance:

A copay is a flat dollar amount you pay when filling a prescription. The exact amount—such as $7, $14, $40, $50 or another figure—depends on:

Your health plan option (Premier PPO, Standard PPO or Limited PPO)
The drug tier (generic, preferred brand or non‑preferred brand)
The number of days’ supply you receive

Example: If your prescription costs $250 and your copay is $14, you pay $14, and your insurance covers the remaining $236. When you use in‑network pharmacies, the copay is the maximum you’ll pay for that medication.

Coinsurance: Coinsurance is a percentage of the drug’s cost that you pay when filling a prescription. Typical coinsurance rates are 20% or 30%, depending on your health plan option (CDHP or Local CDHP).

Example: If your prescription costs $250 and your coinsurance is 20%, you pay $50, and your insurance covers the remaining $200.

How much you pay for a prescription depends on several things including:

*The drug tier
Your choice of a generic, preferred brand, non-preferred brand or specialty drug will help determine price.
The day supply you receive
A 30-day (or less than a 30-day ) or 90-day (or greater than a 31-day) supply.
**Where you fill your prescription.

You may fill your prescriptions at any pharmacy participating in the Partners for Health network.

Retail-30 Network
Fill up to a 30-day supply of medications at most pharmacies nationwide. To see which pharmacies are included, use the Pharmacy Locator tool at
info.caremark.com/stateoftn.

Retail-90 Network
Not all pharmacies in the Retail-30 Network are part of the Retail-90 Network. To check which pharmacies, offer a 90-day supply, use the Pharmacy Locator tool at info.caremark.com/stateoftn.

Specialty Pharmacy Network
Your plan requires specialty medications to be filled through pharmacies in the Specialty Pharmacy Network. Use the Pharmacy Locator tool at info.caremark.com/stateoftn to find participating specialty pharmacies.

Vaccine Network
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.

Mail Service and Delivery

Your prescriptions can be delivered by mail, including 90‑day supplies. Mail delivery is most often used for maintenance medications that are taken regularly, such as those for blood pressure, asthma, diabetes or chronic heart conditions.

You can start using the CVS Caremark Mail Service Pharmacy® for convenient home delivery of your medications through the following options:

Online: Register at info.caremark.com/stateoftn to manage your prescriptions online.
Through your doctor: Your doctor’s office can fax or electronically submit a prescription for a 90‑day supply, along with the appropriate refills. Most prescriptions are sent electronically. Your doctor can also call CVS Caremark Mail Service Pharmacy® at 877.522.8679 to send your prescription.
- New prescriptions: Please allow up to 10 days from the time CVS Caremark Mail Service Pharmacy® receives your request.
- Refills: You must use at least 75% of your medication before requesting a refill through mail service (80% for controlled substances). If you are out of refills and CVS Caremark Mail Service Pharmacy^® needs to obtain a new prescription, it may take up to 10 business days after the mail service pharmacy receives your request for your shipment to arrive. If you are placing a refill for an existing prescription, it may take less time, as refills usually process the same day.
- By mail: Ask your doctor for a written prescription. For the mail service order form, call CVS Caremark customer service at 877.522.8679 or sign in to info.caremark.com/stateoftn. Go to Plan & Benefits and select Print Plan Forms and click on the appropriate mail service order form. Mail the completed form along with your prescription(s) to:

CVS Caremark
P.O. Box 94467
Palatine, IL 60094

Important: To avoid delays, include payment with your order. Please do not send correspondence to this address.

*Prescription Drug Tiers

Tier 1 generic drugs: A generic drug is a U.S. Food and Drug Administration-approved medication that is created to work the same way as a brand-name drug. The FDA has strict standards to help make sure a generic medication is equal to the brand-name product in safety, effectiveness, quality and performance. You pay the least when you fill a prescription with a generic drug.

Tier 2 preferred brand drugs: A preferred brand-name drug belongs to a group of drugs that cost more than generics, but less than non-preferred brands. These are the most cost-effective brand-name drugs for you.

Tier 3 non-preferred brand drugs: A non-preferred brand-name drug belongs to the most expensive group of drugs. You will pay the most if your prescription is filled with a non-preferred brand-name medication.

Medications Prescribed for Obesity: In 2026, members in all plans will pay 25% coinsurance for medications prescribed for weight loss. These medications are limited to a 30-day supply.

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 Partners for Health specialty pharmacy network.

** Find a CVS Caremark Network Pharmacy
To locate a network pharmacy, visit the CVS Caremark website at info.caremark.com/stateoftn and select Search for a Network Pharmacy. You can also call CVS Caremark customer service at 877.522.8679 for help finding a pharmacy near you.

Additional Pharmacy Benefits and Savings

Tobacco quit products
Members who want to stop using tobacco can get free Tobacco Quits Aids.

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 medications and other injectables, needles, test strips and lancets), depression, high cholesterol, asthma/chronic obstructive pulmonary disease 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 uses 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 the 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

Compound Medications
Compounded medications are products that are not commercially available in the strength or quantity prescribed by your doctor. A compounded medication is specifically mixed and prepared for you, based on a prescription from your doctor. To find out if your compound medication is covered, call CVS Caremark customer service at 877.522.8679. Your compounded medication may be subject to prior authorization or benefit exclusion depending on the cost and ingredients.

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.