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General Pharmacy FAQs

What is the formulary list?

The formulary list is a list of medicines that are considered the preferred treatment for a patient's condition and that can be used as a guide for a doctor when prescribing medicine. The formulary list was developed by an independent panel of doctors and pharmacists who worked with the Service Benefit Plan to ensure that the medicines listed were the most clinically appropriate and cost-effective medicines. While your prescription medicine program is not limited to the drugs on the formulary list, using formulary medicines may reduce your out-of-pocket expense. You can find a link to the formulary list here.

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What are the benefits of a formulary list?

The formulary list:

  • Promotes use of prescriptions that could improve patient care and contain costs
  • Empowers the member to be an educated healthcare consumer
  • May encourage members to discuss their prescription medicine treatment with their physicians
  • Aids the physician in making informed decisions based on appropriate clinical and prescribing guidelines

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What if I want to take a medicine that is not on the formulary list?

Medicines that are not listed on the formulary are considered Non-Preferred medicines. You may still receive benefits if you choose a Non-Preferred medicine; however, your out-of-pocket expenses will be greater.

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Where can I obtain a list of prescription drugs that require prior approval?

You can visit CVS Caremark’s website for a list of prescription drugs that require prior approval, along with an explanation of the prior approval criteria, forms, and rationale. Your physician can also provide you with more information concerning prior approvals.

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Are generic medications as safe and effective as brand-name medications?

There are some myths about generic medications. Some people believe that generic medications are not as safe as their brand-name counterparts. Others believe that they are more likely to cause side effects than brand-name medications. The fact is that the FDA mandates that all FDA-approved medications, brand name and generic, must be safe and effective. In order to get FDA approval, the generic medication must contain the same active ingredients as the brand-name product and must meet the same strict quality standards. The generic medication must also be the equivalent in strength and dosage to the original brand-name medication.

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Why are generic drugs less expensive than brand-name drugs?

It's expensive to create a new brand name drug and market it to the public. Generic drug manufacturers do not have those expenses, since they don't pay for the research that led to the discovery of the new drug. Therefore, the medications they produce can cost significantly less for the exact same ingredients, strengths and doses. Those savings are usually passed on to you through lower out-of-pocket costs when generics are selected. Generic medications could lower your out-of-pocket costs by up to 60 percent over the cost of a brand-name medication.

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How can I find out if there is a generic medication for the brand-name drug that I am taking?

There are two ways to find out if the brand-name drug you are taking is available in generic form. You can click on Pharmacy and then follow the prompts to the Standard Option mail or retail pharmacy, or Basic Option retail pharmacy and you will be taken to the CVS Caremark login page. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, follow the prompts to enter drug information. You can also contact the mail service and retail prescription programs at the following toll- free numbers and a customer service representative will assist you.

  • Retail 1-800-624-5060
  • Mail Service 1-800-262-7890
  • Specialty 1-888-346-3731

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How do I find a participating pharmacy?

You can visit our online pharmacy finder or contact the Retail Pharmacy Program 1-800-624-5060 for the most up-to-date listing in your area.

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I have Standard Option. Based on the benefits, is it more beneficial for me to go to my retail pharmacy or through the Mail Service Prescription Drug Program?

This is a decision that is entirely up to you. In order to make an informed decision, you will need to determine the Service Benefit Plan Preferred retail price and your contribution to the cost of the medication. You can then compare the retail coinsurance cost to the flat copayment of $80 for first 30 brand-name prescriptions filled (and/or refills ordered) per calendar year, $50 per brand-name prescription/refill thereafter, and $15.00 for generic medicines if you use the Mail Service Prescription program.

To make sure you are getting the best value check the cost of your prescription drugs on our retail pharmacy site , by using the "price quote" feature on the retail program website. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the brand and generic forms of the drug, if available, for both retail and mail order.

You can also contact the CVS Caremark Customer Care Unit at the following toll- free numbers and ask a customer service representative to assist you.

  • Retail 1-800-624-5060
  • Mail Service 1-800-262-7890

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I have Standard Option. Can you transfer my prescription from the Mail Service Prescription Drug Program to my local pharmacy?

Yes. A valid prescription can be transferred from the Mail Service Prescription Drug Program to your participating retail pharmacy. However, once the prescription is transferred, a new prescription will be needed before the Mail Service Prescription Drug Program can dispense the medicine again.

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I have Basic Option. How do I know what copayment I'll pay for the drug I'm currently taking?

Under Basic Option, there are five copayment levels. The copayment levels are:

  • $10 copayment for generic drugs (30-day supply) 
  • $45 copayment for Preferred brand name drugs (30-day supply) 
  • 50% coinsurance for Non-Preferred brand name drugs, with a minimum $55 copayment
  • $60 copayment (30-day supply) for preferred specialty drugs from a Preferred Retail Pharmacy; or $50 copay copayment (30-day supply) or $140 copayment (90-day supply) for preferred specialty drugs from the Specialty Drug Pharmacy
  • $80 copayment (30-day supply) for non-preferred specialty drugs from a Preferred Retail Pharmacy; or $70 copay copayment (30-day supply) or $195 copayment (90-day supply) for non-preferred specialty drugs from the Specialty Drug Pharmacy

You can find information on which level your medicines are in and the associated cost by visiting the "price quote" feature on the Retail Program Web site where you will be directed to Caremark.com. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the brand and generic forms of the drug, if available, for both retail and mail order.

You may also contact the Retail Prescription Program at 1-800-624-5060 and a customer service representative will assist you.

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I have Basic Option. Why are there different copayment levels for different drugs?

The cost of medicines varies greatly, even though there may be different medicines available to treat the same condition. Generic medicines typically offer the most savings and have the lowest copayment. Brand name medicines generally are more expensive and there can be many different brand name medicines at various cost levels available to treat the same condition.

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I have Basic Option. Can I get my medicine from an out-of-network pharmacy?

If you obtain your medicine from an out-of-network pharmacy, you will be responsible for 100 percent of the medicine's cost.

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Page last updated: December 17, 2013

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