Legal notices
Aetna and CVS Caremark® are part of the CVS Health® family of companies.
Pharmacy benefits
We cover a wide range of prescription and over-the-counter (OTC) medications to help keep our members as healthy as they can be.
Contact us
Questions? Check your provider manual (PDF) for answers. Or call Provider Services at 1-844-365-4385 (TTY: 711). We’re here for you 8 AM to 5 PM, Monday to Friday.
Covered medications
Covered medications
Prescription medications
We cover the prescription medications on the preferred drug list (PDL) with small copays (usually $4), if any. If your patient needs medication, you’ll want to check the list for covered medications, step therapy requirements, quantity limits and updates. You can download the list or check it online.
If a medication isn’t on the PDL, you can:
- Prescribe a similar one that’s on the list
- Get prior authorization (PA) for coverage
Still not sure if we cover a specific medication? Just call 1-844-365-4385 (TTY: 711). We can check it for you. .
Members can get coverage for OTC medications on the PDL(PDF) when they:
- Meet any added requirements (for some medications)
- Get a prescription from their provider
- Fill their OTC prescription at a pharmacy in our network
Not sure what’s covered? Just call us at 1-844-365-4385 (TTY: 711). Be sure to have the member’s list of medications ready. We can check to see if they’re on the list.
Members can get $25 per month per household toward some OTC medications and supplies.
Specialty medications
Specialty medications
If you prescribe a specialty medication, members can fill it at any pharmacy in our network. Not all pharmacies carry these medications, so members may need to find a specialty pharmacy. Some conditions that need specialty medications include:
- Cancer
- Hemophilia
- Immune deficiency
- Multiple sclerosis
- Rheumatoid arthritis
You’ll want to get PA for these medications. Fax the PA form to
1-888-601-8461. Or you can call 1-844-365-4385 (TTY: 711) to ask for PA. You can also include any medical records that may help with the review of your request.
More pharmacy info
Learn about everything from step therapy to PA.
If a member needs prior authorization (PA) for a medication, you can submit PA by:
- Phone: 1-844-365-4385 (TTY: 711).
- Fax: 1-888-601-8461
- Electronic medical record
When members need medication, they’ll:
- Ask you to make sure the medication is on the PDL
- Take their prescription to a pharmacy in our network
- Show their plan member ID card at the pharmacy
Remind members to check with you at least five days before running out of medication. They understand that you may want to see them before prescribing refills.
Members can fill prescriptions at any pharmacy in our network. We can’t cover medications they fill at other pharmacies.
When members take maintenance medication for an ongoing health condition, they can get it by mail. We work with many pharmacies, including CVS Caremark®, to provide this service at no extra cost. Each order is checked for safety. And members can speak with a pharmacist anytime on the phone.
To get started, members will need their:
- Plan member ID card
- Mailing address, including ZIP code
- Provider’s first and last name and phone number
- List of allergies and other health conditions
- Original prescription from their provider (if they have it)
Mail service makes it easy
Members and providers can call CVS Caremark at 1-855-271-6603 (TTY: 711), 24 hours a day, 7 days a week. They’ll explain which medications can be filled with CVS Caremark Mail Service Pharmacy. CVS Caremark will also contact you for a prescription and mail the member’s medication. Members can sign up for mail service:
Online
Members can go to the Member Portal and sign in or register (for new users). Then, they’ll choose: Tasks, Pharmacy services, CVS and Start mail service.
With an order form
Members will ask you to write a prescription for a 90-day supply with up to one year of refills. Then, they can fill out a mail service order form English (PDF) | Spanish (PDF). Or we can mail them a form. They just need to call us at 1-844-365-4385 (TTY: 711).
Members can send the form, along with their prescription, to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110
By phone
Members can also call CVS Caremark at 1-855-271-6603 (TTY: 711). They can call 24 hours a day, 7 days a week. If they agree, CVS Caremark will call you to get a prescription.
The step therapy program requires certain first-line drugs, such as generic drugs or brand-name drugs, to be prescribed before approval of specific, second-line drugs. The PDL identifies these drugs as “STEP.” The Oklahoma Health Care Authority develops the step therapy criteria, as recommended by the Oklahoma Health Care Authority DUR Board.
Certain drugs on the PDL have quantity limits. The PDL identifies these drugs with the letters “QLL.” The Oklahoma Health Care Authority sets the quantity limit for the drug list, as recommended by the Oklahoma Health Care Authority DUR Board. Quantity limits are based on:
- FDA-approved dosing levels
- Nationally established, recognized guidelines related to each condition
Need to ask for an override for step therapy or a quantity limit? Just fax the pharmacy PA form to
1-888-601-8461. Or you can call 1-844-365-4385 (TTY: 711) to ask for PA. You can also include any supporting medical records that may help with the review of your request.
Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332. Or visit the drug recalls page on the FDA website.