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PHARMACY BENEFITS 2017

cvs 

Phone: (855) 465-0032
Website: www.caremark.com 

Click to access or create a CVS/Caremark account

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CVS/caremark is the Pharmacy Benefit Manager for those employees enrolled in the Dartmouth College Open Access Plus Plan (OAP), Cigna Choice Fund Plan(CCF) or the High Deductible Health Plan (HDHP).
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WORDS TO KNOW: a list of commonly used words and definitions relating to your medical plans.

 PRESCRIPTION PLAN COVERAGE

What it is and how it works.  Your Cigna Health Plan includes prescription drug coverage through CVS/caremark.  Refer to the summary chart below that matches your medical plan to see how your plan works and what you can expect to pay, for your prescription drugs.

 DRUG COVERAGE

By using preventive and preferred medicines, you can help make sure you get better value based on your plan and individual needs. Review your Preferred Drug List, updated quarterly, to find out which therapeutic medicines provide you with greater savings.

 TIERED DRUG PRICING

Retail Pharmacy network

(up to a 30-day supply)

Pharmacy OAP CCF HDHP
Preventive $0 $0 $0
Generic   $5   $5 Deductible/Coinsurance
Preferred brand     $25          $30    Deductible/Coinsurance
Non-preferred brand $40 $50 Deductible/Coinsurance

 Caremark Mail Service or CVS Retail Pharmacy

(up to a 90-day supply)

Pharmacy OAP CCF HDHP
Preventive $0 $0 $0
Generic   $10  $10 Deductible/Coinsurance
Preferred brand      $50         $60     Deductible/Coinsurance
Non-preferred brand  $80 $100 Deductible/Coinsurance

 

 WHERE TO GET YOUR PRESCRIPTIONS

Retail Pharmacy Coverage

The CVS/caremark Retail Network includes more than 64,000 participating pharmacies nationwide, including independent pharmacies, chain pharmacies, and 7,300 CVS pharmacy locations.

  • This means that you do not need to go to a CVS pharmacy. You can fill up to a 30 day prescription at any pharmacy within the Retail Network.
  • You may fill up to a 90 day prescription for maintenance medications at one of more than 51,000 Retail-90 CVS pharmacy locations. Your CVS/caremark prescription ID card must be presented when filling a prescription.
  • Pharmacy Locator

Mail Order Pharmacy

Mail-Order Prescription services are also offered, allowing you to receive 90-days of your maintenance medication(s) at a reduced cost.

Setting up your mail order service:

  • The process of setting up a new mail-order prescription may take up to 30 days, so you will want to ensure that you have a supply of your medication on hand when starting the process of setting up your mail-order prescriptions.
  • To begin mail order service, simply mail your original prescription and the mail service order form (pdf) to CVS/caremark.
  • Your medications will be sent directly to your home, office or a location of your choice.
  • To begin mail order service go to www.caremark.com (URL).

 OTHER IMPORTANT PROGRAMS

Advanced Control Formulary

  • The Advanced Control Formulary is a guide to you and your doctor in choosing a clinically appropriate and cost-effective brand-name medicine if a generic is not available
  • Should your medication be excluded from the list, you will receive a notification from CVS/caremark the month prior, identifying your alternatives. We recommend that you discuss these alternatives with your prescriber to identify the safest and most cost-effective treatment for you

Prior Authorization

  • There is a prior authorization requirement for certain specialty medications, which is determined by the Specialty Guideline Management Program. 
  • If a drug you are taking requires pre-authorization, your pharmacist will let you know and your doctor will need to contact CVS Connect for approval.

Drug Savings Review Program

  • Clinicians at CVS/caremark review prescription history to ensure that you are taking the safest and most cost-effective medications available. If CVS/caremark identifies an opportunity to simplify your prescription regimen or find a more cost-effective medication, they will work with your physician to review your medical needs and update your prescriptions if appropriate. Please note, no changes will be made to your prescriptions unless your physician has approved a new therapy.

 MEDICATION EXCEPTION PROCESS

If you have been notified by CVS/caremark that one or more of your prescription medications are no longer covered under the prescription drug plan, and you are unable to take an approved alternative, your physician may submit a written request to CVS/caremark, requesting an exception for coverage of the medication in question. This is an industry standard request that your physician should be familiar with, however, if they are not, the three step process is listed below:

STEP 1:  Written Request – The physician will need to prepare a written request to CVS/caremark that includes the following information: "medical necessity" for the medication in question; names of alternative medications tried; dates the alternative medications where tried; results or reasons why the alternative medications were not viable; and any other information that was pertinent to the decision making process. The Physician's signature, date signed, office address and phone number must also be included on the request.

STEP 2: Fax Request – The physician's office will need to send a fax to (866) 443-1172.

STEP 3: Questions/Results – Questions regarding the exception process, or results of the application should be directed to CVS Caremark Member Services at (855) 465-0032. Results can take up to 72 hours.

 

 CONTACT INFORMATION

CVS/caremark

  • Customer Service: (855) 465-0032
  • Website: www.caremark.com

 

BENEFITS OFFICE

For questions on enrolling in medical insurance or making changes to your medical insurance:

For questions on your membership, coverage, or to request new ID cards, you should contact CVS directly

Last Updated: 3/22/17