All trademarks are the property of their respective owners.
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 may or may not have small copays.
You can check the PDL (PDF). If your medication isn’t on this list, ask your provider to:
Prescribe a similar one that’s on the PDL
Get prior authorization (PA) for coverage
If you need a prescription for diabetes supplies, here’s a list of preferred ones:
Preferred glucose meter and test strips: Lifescan OneTouch® products
Preferred lancets and lancing devices: Lifescan OneTouch Delica® and Delica® Plus
Preferred pen needles: Becton Dickinson (BD) products
Preferred continuous glucose monitors (CGMs): Dexcom G6 and Freestyle Libre (both require prior authorization)
For medications not on this list, your provider will need to get PA.
Need PA? Just ask your provider to complete PA. Or they can call 1-866-316-3784 (TTY: 711).
PDL (PDF)
Still not sure if we cover your medication? Just call 1-866-316-3784 (TTY:711). When you call, have a list of your prescription medications ready. We can check them for you.
Not all covered drugs are listed on the PDL. You may also check the Common Formulary (PDF). Or refer to these other resources:
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.
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 1-866-316-3784 (TTY: 711). When you call, have a list of your OTC medications ready. We can check them for you.
You should have everything you need to help you feel your best. That’s why we’re working with CVS Health® to give you $25 of OTC health supplies and products. And we'll send it to you every month at no extra cost.
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. CVS Caremark will then send you a mail service order form. Fill out the form.
Send the form, along with your prescription, to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110
Medication recalls
Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332.
More pharmacy info
Learn about everything from pharmacy access and rules to prior authorization.
The PDL is up to date with covered medicines. Remember that some medications need PA before you can get them.
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. Your usual pharmacy will order the medicine in the meantime. 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 appeals, visit our grievances and appeals page.
Our PA process is designed to approve drugs that are medically necessary.
We require doctors to get PA before prescribing or giving out certain medications or supplies, including:
Injectable drugs provided by a pharmacy
Non-formulary drugs that aren’t excluded under a state’s Medicaid program
Prescriptions that do not follow our guidelines (like quantity limits, age limits or step therapy)
Brand-name drugs, when you can use a generic drug
Our medical director approves drugs using guidelines from the Michigan Department of Health & Human Services (MDHHS). They may need more info before making a decision. This info may include details about things, like:
Drugs on the PDL that were used and do not work (ex: step therapy)
The PDL not having any drugs that work as well as the drug requested
Proof that the request is acceptable by the Federal Drug Administration (FDA) or is accepted by nationally noted experts
A completed FDA MedWatch form showing failure or issues with the generic drug (for brand-name drug requests)
More about our PA process
We will:
Tell you and your provider our decision by phone or mail
Fill prescriptions for a seventy-two (72) hour supply if you are waiting for us to make a decision
If a drug is not listed on the formulary, your provider will need to complete a pharmacy PA request form. They must also:
Explain why a formulary drug will not work for you
Include any medical records needed for the request
We partner with MDHHS in the We Treat HEP C program to provide treatment for members who have hepatitis C.
Hepatitis C treatment no longer requires PA if using the state-preferred PDL agent, MAVYRET®.
Want to learn more? See commonly asked questions for hepatitis C treatment.
When you take your prescription to an in-network pharmacy, just show your member ID card.
The pharmacy will need your ID card to gather this info:
BIN: 610591
PCN: ADV
GROUP: RX8826
Providers: For payer sheets and other network or processing info, just visit the CVS Caremark® website.
Contact us
Call Member Services at 1-866-316-3784
(TTY:711). We’re here for you Monday through Friday, 8 AM to 5 PM.