4 easy tips to get the most out of your pharmacy benefits
Find out how the CVS/Caremark app can make managing your prescriptions easier, how to know what medication is covered, where to get specialty drugs filled and more!
1. Begin with the basics
Knowing which plan you have will help you understand how much you pay for different prescriptions. The Low Rx plan comes with the medical plan at no charge. High Rx is available for an additional cost. If you aren’t sure which plan you are enrolled in, check your pharmacy ID card.
2. Download the CVS/Caremark mobile app
You can order prescription refills, set refill reminders, view your I.D. card, check drug coverage and costs, check the status of your prescription order, research drug information, view your prescription history, locate a pharmacy near you, and more! To download the app, search for CVS/Caremark from your Apple or Android phone.
3. Review the formulary list to know what is covered
Our formulary (list of covered drugs) excludes drugs with generic alternatives. To view the list of covered medicines, go to http://info.caremark.com/highvalue plan and click View Drug List.
- If you visit your doctor and need medication, ask your doctor to prescribe a generic version of the medication needed. Before you fill a prescription, always check to be sure the medication is on the formulary list, which is updated each quarter.
- Some brand drugs require prior authorization, step therapy (trying an alternative drug first) and/or quantity limits.
- Prior Authorization: This means that your doctor must contact CVS/ Caremark (1-855-582-2026) and confirm that a specific medication meets plan guidelines for covering your condition.
- Step Therapy with Post-Step Prior Authorization: You must try a lower-cost alternative before a higher-cost medication will be covered. If you have a unique medical situation where the lower-cost alternative doesn’t work well for you, your doctor must contact CVS/Caremark (1-855-582-2026) and confirm that a specific medication is clinically necessary for your condition.
- Quantity Limit: The plan limits the amount of a specific medication that you can fill in a 30-day or 90-day period. If you have a unique medical situation that requires you to exceed the limit, your doctor can contact CVS/Caremark (1-855-582-2026) and confirm that a higher quantity is clinically necessary for your condition.
4. Specialty Prescriptions and Maintenance Medications: What are they and where do they get filled?
- Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis. Specialty drugs often require special handling (like refrigeration during shipping) and administration (such as injection or infusion). While they help a smaller number of people, these prescriptions are expensive! If you are required to take a specialty drug, two great options to fill our prescription are available:
- Going beyond filling prescriptions, the Texas Health Specialty Pharmacy team helps provide ongoing support throughout your treatment plan, including education, cost savings, pharmaceutical counseling and medication reconciliation before every refill. Additionally, the Texas Health Specialty Pharmacy team helps collaborate with insurance providers to verify you receive maximum benefits, and even helps search for financial assistance from manufacturers, foundations and other resources. The centrally located Texas Health Specialty Pharmacy team coordinates the dispensing and delivery of specialty medications via Texas Health’s existing retail pharmacies at Texas Health Prescription Shop Dallas and Texas Health Prescription Shop Plano. To get started, call 682-236-2500.
- You can also call the CVS Specialty Pharmacy at 1-800-237-2767 to get started on filling a specialty medication or take your prescription to any CVS Pharmacy retail location to get the prescription information entered into the system. You can then choose to have the prescription mailed to your home, or to pick it up at a CVS retail pharmacy, depending on the medication’s availability.
- Maintenance Medications
Maintenance medications are medications that your physician prescribes for chronic or long-term conditions. Mail order is required for maintenance medications on the third time you fill it.
- You are required to refill maintenance medications with a 90-day supply through Caremark’s mail order program, at the Texas Health Dallas, Plano, or at your local CVS or Target pharmacy. Otherwise, you will pay double the retail charge after the second time you fill the prescription. If you are not sure if the prescription is for a chronic condition, please check with your pharmacist.
- If your physician gives you a new prescription for a maintenance medication, ask for a 30-day prescription that you can fill immediately and a 90-day prescription that you can fill for ongoing use. Take the 30-day to get filled at your normal pharmacy, and then order a 90-day supply of your prescription at the retail pharmacy at Texas Health Dallas or Plano, through Caremark mail order or at any CVS Pharmacy.