The Funds does not currently cover these medications. However, they may be authorized if these drugs are being prescribed for other purposes. For more information, please contact CVS Caremark’s Prior Authorization Department at 1-800-294-5979.
The Funds has a process in place to have a drug approved under a “medical necessity” provision by your doctor. Your doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the non-preferred or brand name medication should be dispensed, if authorized there is no additional charge.
If you are not currently using mail service, consider signing up for your maintenance medication needs. Depending on your drug benefit design, there may be a significant financial advantage to you if you do so. This is in addition to the convenience of home delivery and savings on gas and time. To enroll in the mail service program you can contact the Funds’ “FAST START” department at 1-800-294-4741. Be prepared to provide information about you, your doctor and the prescriptions that you routinely take. If you prefer to use to mail service paper form to start your service, please click here.
Yes, the Funds requires that generic forms of medications are used when available. If a brand name drug is filled when a generic is available, then there is a charge equal to the difference of the cost of the medication for the two prescriptions. This charge is in addition to your copayment for the prescriptions.
If you have already tried and cannot take the generic drug due to a specific medical reason(s), your doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information concerning why the generic medication should not be dispensed. If the exception request is approved, you will only pay the standard copayment.”
The CVS Caremark logo appears on the card because they are the Funds’ pharmacy benefit processor. You may continue to use your current pharmacy. The Funds has elected a network of over 68,000 pharmacies for you to choose from including all of the major chains and many hundreds of independent pharmacies, as well.
A significant number of prescriptions written for Funds’ beneficiaries are drugs for sleep, diabetes and high blood pressure. The Funds’ Pharmacy and Therapeutics Committee, a committee of doctors and pharmacists, carefully selected a list of preferred drugs for each condition. The preferred drugs are clinically effective and similar to other drugs that treat the same condition. More information about the program and drug lists are available here.
Your doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the preferred medication should not be dispensed. If approved, the you will be authorized to receive one of the ”non-preferred” products at the standard co-payment.
Information about the Preferred Product Program is available here. From there you will link to plan specific Preferred Product Program information with Preferred Drug Lists. You doctor can order a drug on the preferred list if it is right for you. Non-preferred medications are also provided for you and your doctor’s reference. If your doctor feels you should require a non-preferred medication, there are links to a medical necessity form to request approval for these products.
If you cannot take a preferred product due to a specific medical reason(s), your doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the preferred medication should not be dispensed. If approved, you will be authorized to receive a “non-preferred” product at the standard copayment
* Please note: If you are on a drug that is not on the preferred product list, the requirement that you first try the preferred drug, in the absence of a medical exception from your doctor, does not apply to you.