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Medications your plan covers

Medications your plan covers

Prescription medications

 

We cover the prescription medications on the formulary (or drug list). These medications need to be medically necessary. This means you need them to manage a health condition. FAMIS members may have small copays. For more info, see the copay chart in your member handbook — English (PDF) | Spanish (PDF)

 

You can check the formulary (PDF). Or search it online. If your medication isn’t on this list, ask your provider to:

 

  • Prescribe a similar one that’s on the formulary
  • Get prior authorization (PA) for coverage

 

Need PA? Just ask your provider to complete PA. Or they can contact us.

 

Formulary (PDF)

 

Formulary search tool and updates

 

Do you have both Medicare (Part A and/or Part B) and Medicaid coverage? If yes, that means you’re dual eligible. In this case, you can check the formulary for dual-eligible members.

 

Dual-eligible formulary (PDF)

 

Still not sure if we cover your medication? Just contact us. When you call, have a list of your prescription medications ready. We can check them for you.

Other drug lists

 

Do you take medication for a chronic (long-term) condition? If so, you’re covered for up to a 90-day supply. To become eligible, you must’ve received two 30- to 34-day medication fills in the past 120 days. If you received more than a 34-day supply with Aetna Better Health® of Virginia, you don’t need to meet the two-fill requirement. If a medication isn’t on the formulary, you can get coverage for up to a 34-day supply.

 

90-day supply list (PDF)

 

You can see a preview of the list of the medications for January 2022 (subject to change).

 

Formulary (2022) (PDF)

 

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 formulary (PDF) or dual-eligible formulary (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 contact us. When you call, have a list of your OTC medications ready. We can check them for you.

Get medications and refills

Get medications and refills

If you need medication, your provider will write you a prescription for one on the formulary. You’ll want to:

 

  • Ask your provider to make sure the medication is on the formulary
  • 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 me

 

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 —  English (PDF) | Spanish (PDF)

Send the form, along with your prescription, to:

CVS Caremark 
PO Box 2110  
Pittsburgh, PA 15230-2110

Specialty medications

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. 

 

You can also fill your specialty medication through CVS Specialty® pharmacy. Just call 1-800-237-2767 (TTY: 711).

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

 

What is the Patient Utilization Management and Safety (PUMS) Program?


It’s a care coordination program that helps ensure members are getting and using services in a safe way. Members choose one in-network pharmacy to fill their prescriptions and stick with it. If members are having trouble choosing a pharmacy, case management can help them.

 

What happens if my pharmacy is closed?


A different pharmacy can call the pharmacy help desk and get you a one-time override for emergency prescriptions. You may want to choose a pharmacy that has extended hours or is open 24 hours a day, 7 days a week.

  

What happens if I no longer want to use the pharmacy?


Contact your care coordinator. You can talk with them about other options to meet your needs.

 

Contact us

Questions? Just contact us. We’re here for you 24 hours a day, 7 days a week.