Frequently Asked Questions

About the Retail Program

Can I receive additional prescription ID cards?

Additional prescription ID cards may be obtained by contacting Caremark Customer Care toll-free at (888) 886- 8490.

May I obtain my medicine from a non-participating pharmacy?

In most instances, you will not need to visit a non-participating pharmacy because there are more than 54,000 participating pharmacies in the Caremark program. When you choose to go to a non-participating pharmacy, you will pay 100 percent of the prescription price. You may then submit a paper claim form, along with the original prescription receipt(s), to Caremark for reimbursement of covered expenses.

How do I transfer my prescription from a non-participating retail pharmacy to a Caremark participating retail pharmacy?

Go to a Caremark participating retail pharmacy and tell the pharmacist where your prescription is currently on file. The pharmacist will contact the pharmacy and make the transfer for you. To find a participating pharmacy near you, click on the Pharmacy Locator link under Quick Links.

When should I use a retail pharmacy instead of the mail service program?

You can use a retail pharmacy for up to a 30-day supply of non-maintenance and short-term drugs. If the drug is a maintenance drug, you will pay an extra fee. The mail service program administered by Caremark provides a convenient and cost-effective way for you to order up to a 90-day supply of a long-term or maintenance medicine for direct delivery to you with free standard shipping.

When should I use an Extended Days' Supply (EDS) Network Pharmacy?

An EDS Network Pharmacy allows you to purchase a 31-to 90-day supply of maintenance drugs without paying a retail maintenance fee. A 30-day supply of maintenance drugs still carries an extra fee.

Do I need my doctor to write a new prescription for a 31-to 90-day supply of maintenance drugs at an EDS network pharmacy?

Yes, you may have to get a new prescription from your doctor if your current prescription is written for a 30-day or less supply of maintenance or long-term medicine.

About the Mail Service Program

Why should I use the mail service program for my prescriptions?

The mail service program administered by Caremark provides a convenient and cost-effective way for you to order up to a 90-day supply of long-term or maintenance medicine for direct delivery to you with free standard shipping. By using your mail service program, you minimize trips to the pharmacy while saving money on your prescriptions.

How long does it take for my prescriptions to arrive by mail?

Your medicine will be delivered within 10 days from the time your order is received.

How do I check on the status of my order?

Log in, go to the Prescriptions tab and click View Order Status or call Caremark Customer Care toll-free at (888) 886-8490.

How should I ask my doctor to write my prescription to receive the maximum benefit from the mail service program?

Remind your doctor to write “90-day supply plus refills”, when clinically appropriate, for long-term medicines that are purchased through the mail service program administered by Caremark. Caremark must fill your prescription for the exact quantity of medicine that your doctor prescribes, up to your plan design limit. When you need to take your maintenance medicine right away, ask your doctor for two prescriptions – one for up to a 30-day supply and one for up to a 90-day supply with refills, when clinically appropriate. Have the 30-day supply filled immediately at a Caremark participating retail pharmacy and send the 90-day supply prescription to the mail service program.

About the Preferred Drug List

What is a drug list?

A drug list is a list of preferred prescription medicines that have been chosen because of 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 (FDA) for safety and effectiveness. Generic medicines typically cost much less than brand name medicines.

Where can I obtain a drug list?

Log in, go to the Plan & Benefits tab and click Covered Drug List (Formulary). You may also contact Caremark Customer Care at (888) 886-8490. To save money, have your doctor prescribe a generic or preferred brand-name medicine from the Preferred Drug List. You may want to take this list with you when you visit your doctor for a prescription.

What drugs require prior authorization?

Your health plan participates in a prior authorization program for specific prescription drugs. This means that you must get authorization before benefits can be paid for these drugs.

Drug Coverage and Cost Quick Links

What is the difference between the “HealthSelect of Texas Drug Costs” quick link and the “Consumer Directed HealthSelect Drug Costs” Quick Link?

The "HealthSelect of Texas Drug Costs" quick link provides your out-of-pocket costs and drug coverage for the existing HealthSelect of Texas Prescription Drug Program.

The “Consumer Directed HealthSelect Drug Costs” quick link provides your out-of-pocket costs and drug coverage under the new Consumer Directed HealthSelect Prescription Drug Program available September 1, 2016. You can compare your expected drug costs under both prescription drug programs so you can decide which program is right for you.

In addition, the “Consumer Directed HealthSelect Drug Costs” quick link lets you see your estimated drug costs in the Consumer Directed HealthSelect Prescription Drug Program, both before and after your deductible has been met.

Please note that the drug cost tools only give cost estimates. The actual cost of your medication may change. The tool cannot anticipate emergency costs.

How do I use the Drug Coverage and Cost tool?

To check if a drug is covered and receive a cost estimate for the HealthSelect of Texas Prescription Drug Program, navigate to the HealthSelect of Texas Plan Summary page and click on the Check Drug Coverage and Cost link.

Click on “Consumer Directed HealthSelect Drug Coverage and Cost BEFORE I’ve Met My Deductible” to get the drug cost estimate before you’ve met your deductible on the Consumer Directed HealthSelect Prescription Drug Program. Or click “Consumer Directed HealthSelect Drug Coverage and Cost AFTER I’ve Met My Deductible” to get the drug cost estimate after you’ve met your deductible.

Enter the drug name or the first three letters of the drug name, and the prescribed drug strength. Then click “Search” to get a drug cost estimate. If there is a generic option for a brand-name drug, the tool will show you both the cost of the brand-name drug and the generic option.

What do I need to know when using the Drug Coverage and Cost tool?

The results page will let you know if a drug is covered by the program, whether it requires prior approval and other important coverage notes. The results page includes the estimated cost if you fill the drug by mail or retail, and the cost for the most common generic option, if applicable. The lowest cost option is highlighted.

Please note that the drug cost tools only give cost estimates. The actual cost of your medication may change. The tool cannot anticipate emergency costs.

Are the costs I see in the HealthSelect of Texas Drug Costs and Consumer Directed HealthSelect Drug Costs tools guaranteed when I fill my medication?

No, the costs you see are only estimates and are subject to change. Drug coverage and cost estimates are based on commonly dispensed products for the drug name, strength, dosage form and package size. Actual coverage and pricing may vary at the time you fill the medication.

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