♦ CVS Caremark Prescription Chart (OAP1 and OAP2)
♦ CVS Caremark Prescription Chart (HDHP)
♦ Check Availability and Costs
♦ Medication Exception Process
• 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 prescriptions at any pharmacy within the CVS Retail Network.
• Your CVS Caremark prescription ID card must be presented when filling a prescription.
• The retail pharmacy copayment tiers for OAP 1 and OAP 2 are $5 for generic prescriptions, $25 for preferred brand-name and $40 for Non-nreferred brand-name prescriptions.
• The retail pharmacy copayment for the HDHP plan is $0 for all three tiers, once the deductible is met.
• Mail-Order Prescription services are also offered, allowing you to receive 90-days of your maintenance medication(s) at a reduced cost. It is important to remember that 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 to CVS Caremark. Your medications will be sent directly to your home, office or a location of your choice. You also have the convenience of getting your long-term medications at one of more than 51,000 Retail-90 Pharmacy locations. To locate a Retail-90 Pharmacy or to begin mail order service go to www.caremark.com/dartmouth
• The mail order pharmacy copayment tiers for a 90 day prescription on the OAP1 and OAP2 plans are $10 for a generic prescription, $50 for a preferred brand-name prescription and $80 for a non-preferred brand-name prescription.
• The retail pharmacy copayment for the HDHP plan is $0 for all three tiers, once the deductible is met.
• Check Availability and Costs of Prescription Drugs
• CVS Caremark Performance Drug List
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:
♦ 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.
♦ Fax Request – The physician's office will need to send a fax to (866) 443-1172.
♦ 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.
Phone: (855) 465-0032
Website: http://www.caremark.com/dartmouth
For questions on enrolling in medical insurance or making changes to your medical insurance:
Phone: (603) 646-3588
Website: http://www.dartmouth.edu/~hrs/benefits/
E-mail: human.resources.benefits@dartmouth.edu
Fax: (604) 646-1108
Mailing Address: Office of Human Resources Office 6042, 7 Lebanon Street, Suite 203, Hanover, NH 03755
For questions on your membership, coverage, or to request new ID cards, you should contact CVS Caremark directly.
