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Pharmacy benefits

Need medication? Your pharmacy benefits include a wide range of prescription and over-the-counter (OTC) medications to keep you as healthy as you can be. 

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). Or check the PDL online. 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

 

Need PA? Just ask your provider to complete PA.  Or they can call 1-844-365-4385 (TTY: 711).

PDL (PDF)

 

 

Still not sure if we cover your medication? Call 1-844-365-4385 (TTY: 711). When you call, have a list of your prescription medications ready. We can check them for you.

Understand your medication

 

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. Or find answers to your questions in our pharmacy FAQs.

Pharmacy FAQs

 

OTC medications

 

You can get coverage for some OTC medications on the PDL (PDF) 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 1-844-365-4385 (TTY: 711). When you call, have a list of your OTC medications ready. We can check them for you.

 

$25 for OTC products

 

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.
 

More about your OTC benefit

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

 

In person

 

You can fill your prescriptions at any pharmacy in our network. We can’t cover medications that you fill at other pharmacies.

 

Find a pharmacy near you

 

By mail

 

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. Then, fill out a mail service order form:

Mail service order form – English (PDF)

Mail service order form – Spanish (PDF)

Send the form, along with your prescription, to:    

CVS Caremark   
PO Box 2110    
Pittsburgh, PA 15230-2110   

Specialty medications

Some conditions that need specialty medications include:

 

  • Cancer
  • Hemophilia
  • Immune deficiency
  • Multiple sclerosis
  • Rheumatoid arthritis

Do you have a prescription for a specialty medication? If yes, you can fill it at any pharmacy in our network. Not all pharmacies carry these medications. So you may need to find a specialty pharmacy. 

 

Your provider may need to get PA for some medications.

Medication recalls

 

Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332. 

 

Medication recalls



 

Pharmacy access and rules

 

The PDL (PDF) 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. You can also do this in an emergency. 

  

What if I don’t want to use only one pharmacy?

 

You can file an appeal. You have 60 days to file an appeal from the date on your letter about the Lock-in program. To learn how to file an appeal, you can visit our grievances and appeals page.

Contact us

Questions? Just call Member Services at 1-844-365-4385 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.

Legal notices

Aetna and CVS Caremark are part of the CVS Health® family of companies.

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