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Medications your plan covers
Medications your plan covers
Prescription medications
We cover the prescription medications on the preferred drug list (PDL). These medications need to be medically necessary. This means you need them to manage a health condition.
You can check the downloadable PDL (PDF). Or check it using our online search tool. If your medication isn’t on this list, ask your provider to prescribe a similar one that's on the PDL.
The state updates the PDL regularly. Updates may include info about the addition and/or removal of:
- A medicine from the PDL
- Quantity limits
- Prior authorization (PA) requirements
You can find the most up-to-date PDL using our online search tool.
Diabetes prescriptions
If you need a prescription for glucose meter and test strips, Johnson & Johnson OneTouch® products are preferred. The preferred pen needles and insulin syringes are BD products.
Need PA? Just ask your provider to complete PA. Or they can call Provider Experience at 1-855-221-5656 (TTY: 711).
Still not sure if we cover your medication? Just call 1-855-221-5656 (TTY: 711). When you call, have a list of your prescription medications ready. We can check them for you.
Be sure to tell your providers about all the medications you take. This includes over-the-counter medications, vitamins and supplements. Understand what your medication is for and how to take it. Check out these medication tips. Or find answers to your questions in our pharmacy FAQs (frequently asked questions).
You can get coverage for some OTC medications on the PDL when you:
- Meet any added requirements (for some medications)
- Get a prescription from your provider
- Fill your OTC prescription at a pharmacy in our network
Still not sure if we cover your medication? Just call 1-855-221-5656 (TTY: 711). When you call, have a list of your OTC medications ready. We can check them for you.
As well as standard coverage for some OTC products on the PDL, we added another OTC benefit for you. Enjoy $25 per month (per household) toward some OTC medications and supplies. We’ll mail them directly to you. Just have your member ID number ready when you place your order:
Online: Just sign in with your member ID and password. Or create a new account if you’re a first-time visitor.
By phone: You can call OTC Health Solutions at 1-888-628-2770 Monday through Friday, 9 AM to 8 PM CT.
By fax: Fax your completed form to 1-866-682-6733.
By mail: Mail your form to the address on the form.
Get medications and refills
Get medications and refills
If you need medication, your provider will write you a prescription for one on the PDL. You’ll want to:
- Ask your provider to make sure the medication is on the PDL
- Take your prescription to a pharmacy in our network
- Show your plan member ID card at the pharmacy
Need refills? Your medication label notes how many refills you have. Call your pharmacy to place a refill order well before you run out of medication. If your prescription is out of refills, check with your provider at least five days before you run out of medication. They may want to see you before adding refills.
Fill your prescriptions
You can fill your prescriptions at any pharmacy in our network. We can’t cover medications that you fill at other pharmacies.
Do you take medication regularly for a chronic (long-term) condition? If yes, you may be able to get medication by mail. Read on to learn more about starting mail service.
Get started with mail service
You can sign up for mail service:
Online
Log in to your Member Portal. Go to “Tasks” and then “Pharmacy Services.” Go to Caremark.com by clicking on the “CVS” link. Then, choose “start mail service” to print the mail-order form.
By phone
Just call CVS Caremark® at 1-855-271-6603 (TTY: 1-800-231-4403). You can call 24 hours a day, 7 days a week. If you say it’s okay, they’ll call your provider to get a prescription.
With an order form
Ask your provider to write a prescription for a 90-day supply with up to one year of refills. Then, fill out a mail service order form — English (PDF) | Spanish (PDF).
Send the form, along with your prescription, to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110
Specialty medications
Specialty medications
Do you have a prescription for a specialty medication? If yes, you can fill it at any pharmacy in our network. Not all pharmacies carry these medications. So you may need to find a specialty pharmacy.
Your provider may need to get PA for some medications.
Medication recalls
Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332.
Pharmacy access and rules
What is the Pharmacy Lock-in program?
This program helps to prevent potential abuse or misuse of medical or pharmacy benefits. Members choose one in-network pharmacy to fill prescriptions and stick with it.
What happens if my pharmacy doesn’t have the medicine I need?
You’ll be able to get a 72-hour supply of medicine from a different pharmacy. You can also do this in an emergency.
What if I don’t want to use only one pharmacy?
You can file an appeal. To learn more about how to file an appeal, just visit our grievances and appeals page.
Contact us
Questions? Just call Member Services at 1-855-221-5656 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.