FAQs and Answers
What is a co-payment, co-insurance, or co-pay?
Co-payment, co-insurance or co-pay means the amount a plan participant is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan.
Will I receive a new ID card?
Yes, you will be receiving new ID cards in the mail prior to June 1, 2008. You should begin using this new ID card on June 1, 2008. Until June 1st, please continue using your current ID card.
Can I receive additional ID cards?
Additional ID cards may be obtained by contacting Customer Care via your toll-free number.
May I obtain my medicine from a non-participating pharmacy?
You are required to use a CVS/pharmacy (there are over 6,200 available) for your retail benefit unless you do not have a CVS/pharmacy within 5 miles of your home address. If you do not have a CVS/pharmacy within 5 miles of your home address, you will have access to a broader network with over 62,000 participating pharmacies nationwide. If you choose to go to a non-participating pharmacy, instead of a CVS/pharmacy or a participating pharmacy, you will pay 100 percent of the prescription price. You may then submit a paper claim appeal form, along with the original prescription receipt(s), to Caremark for possible reimbursement of covered expenses.
What’s different about the new Prescription Plan?
The new prescription drug plan is easier to use and saves you money. You’ll be able to fill 90-day supplies of maintenance medications at a CVS/pharmacy or through Caremark Mail Service. The cost to you will be the same either way—and less than if you refilled it every 30 days. The new plan also uses the new CVS Caremark Preferred Drug List. If you’re taking a drug that was non-preferred, it may be on the new preferred drug list—which means you’ll save money (if there’s a change to the preferred status of a drug you’re currently taking, you’ll get a letter in the mail from Caremark)!
What drugs will require prior authorization?
Beginning June 1, 2008, the following drugs will require prior authorization:
- ADHD Medications
- Anabolic Steroids
- Anti-Fungal Medications
- Antipsoriatic Agents
- Asthma Drugs
- Cosmetic - Injectables
- Cosmetic - Topical Retinoids
- Crohn’s Disease / Rheumatoid Arthritis
- Growth Hormones
- Immune Globulins
- Insulin Like Growth Factors
- Iron Chelator
- Narcolepsy Drugs
- Osteoporosis Drugs – Injectables
- Pulmonary Arterial Hypertension (PAH)
- Rheumatoid Arthritis
- RSV agent (Respiratory Syncytial Virus)
What drugs will have quantity limits?
Beginning June 1, 2008, the following drugs will have quantity limits in place*:
- Butorphanol NS / Stadol NS
- Glucose monitors
- Opana ER
- Panlor DC
- Relenza Diskhaler
- Sedative Hypnotics (Ambien CR; Lunesta; Rozerem; Sonata; Temazepam; Zolpidem)
- Synalgos DC
- Toradol, ketorolac
- Vicodin HP
*Your plan reserves the right to make additions as needed to this listing.
How long does it take for my prescriptions to arrive by mail?
You can expect to receive your prescription approximately 10 to 14 calendar days after Caremark receives your order.
How do I check on the status of my order at mail?
You can check your refill order status at www.caremark.com (after 6/1/2008) or by dialing Caremark Customer Care via your toll-free number.
What is a CVS Caremark Preferred Drug List?
CVS Caremark Preferred Drug List is a list of preferred prescription medicine that has been chosen because of their clinical effectiveness and safety. This list is typically updated every three months. The drug list promotes the use of preferred brand name medicines and generic medicines whenever possible. Generic medicines are therapeutically equivalent to brand name medicines and must be approved by the U.S. Food and Drug Administration for safety and effectiveness. Generic medicines also cost much less than brand name medicines.
Where can I obtain the CVS Caremark Preferred Drug List brochure?
You can obtain the drug list brochure by either accessing www.caremark.com (after 6/1/2008) or by contacting Customer Care via your toll-free number. To save money, have your doctor prescribe a generic or preferred brand name medicine from the CVS Caremark Preferred Drug List. You may want to take it with you when you visit your doctor for a prescription.
What are long-term or maintenance medicines?
Long-term or maintenance medicines are drugs that you will be taking for more than one treatment cycle; that is, they are medicines that you will need to have refilled several times. Common maintenance medicines are those used to treat chronic conditions like high blood pressure, diabetes, asthma, depression, and ulcers. Ordering through the Caremark Mail Service Pharmacy or a CVS/pharmacy is a convenient way to fill prescriptions for maintenance medicines.
What are short-term medicines?
Short-term medicines are used to treat acute conditions—most coughs, colds, flu, and infections. If you have been prescribed a short-term medicine you should probably begin taking it as soon as possible. Fill such prescriptions at a CVS/pharmacy.
What are Specialty Pharmacy Services?
Certain disorders require special pharmacy products, often in the form of injected medicine. These disorders include cancer, multiple sclerosis, growth hormone disorders, immune deficiencies, and more. Caremark provides special support for these participants including 24-hour access to pharmacy services and emergency pharmacist consultation as well as ongoing support and counseling. Learn more about our Specialty Pharmacy Services at www.caremark.com (after 6/1/2008).