Active Members and non-Medicare Retirees

These prescriptions can be filled at any in-network pharmacy (CVS, Target, Walgreens etc.).  To locate an in-network pharmacy closest to you, register on www.caremark.com (linked above)!

You may receive up to two 30-day supplies of a short-term medication, but if you seek a third refill of that medication it is no longer considered short-term. When seeking a third refill it is now considered a long-term medication (maintenance medication), and you must transition to a retail CVS, Costco or Kroger Pharmacy, or use the CVS Caremark Mail Service Pharmacy to obtain a 90-day supply. You do have the option to stay at your current pharmacy for that refill; however, for any future refills you will be responsible to pay 100% of the cost of the medication. Please note, if you choose to pay the 100% of the cost no reimbursement will be allowed.

These prescriptions can be filled at the following pharmacies for a 90-day supply:

• Retail CVS Pharmacies
• CVS Caremark Mail Service Pharmacy
• Costco Pharmacies
• Kroger Pharmacies

Let your physician know which pharmacy you would like to use so they can accurately submit your prescriptions.

Please note that all prescriptions must be written for a 90-day supply when using the CVS Caremark Mail Service Pharmacy. If the prescription is written for anything less than 90-days, you will still be responsible for paying a 90-day copayment.

• For assistance regarding CVS Caremark Mail Service Pharmacy, you can contact CVS Caremark Member Customer Service at 833-252-6642

Our program offers a convenient 4-tier structure.  If the cost of the medication is less than your copay, you are only responsible for paying the lower amount. Our 4-tier structure is as follows:
• Generic Medication (Tier 1)
• Preferred Brand Name Medication (Tier 2)
• Non-preferred Brand Name Medication (Tier 3)
• Specialty Medication (Tier 4)

Yes! The Performance Drug List is linked at the top of the page. This is a guide within select therapeutic categories for Plan members and health care providers. Ask your physician to consider prescribing generic medication as a first line option, when medically appropriate. Generic medications are typically a lower cost to the plan, and these savings are immediately passed directly to the membership. If there is no generic available, there may be a preferred brand name medication listed.

When available, generic medications will be substituted for all brand name medications. If you request the brand name, or if the prescribing physician indicates “no substitutions”, when a generic equivalent is available, you will be required to pay the brand name copay plus the difference in cost between the brand and its generic equivalent, unless determined medically necessary through the appeals process.

If your prescription is rejecting due to a PA required, the pharmacy should reach out to your physician.  In the event that your physician does not receive this information from the pharmacy, or you would like to expedite the PA process, we recommend that you follow up with your physician’s office.

Your physician can initiate a PA by the following:

• Electronic (ePA) – preferred
  • CoverMyMeds:
    https://www.covermymeds.health/prior-authorization-forms/caremark

OR

• • SureScripts: https://sso.surescripts.net/account/login
• By Phone –
  • CVS Caremark by calling 1-800-294-5979

All PA’s are reviewed by clinicians at CVS Caremark, not the Pharmacy Benefit Department at the Fund Office.

If you would like to check on the status of your PA, contact CVS Caremark Member Customer Service at 833-252-6642.

Active Plans ONLY:

The Plan provides coverage for certain Preventive Care Medications as required by the ACA. Coverage is provided on an in-network basis only, with $0 cost-sharing for the member.

A prescription from your physician is needed, and please be sure to present your Vendor ID card containing the CVS Caremark billing information.

To view the current list of covered Preventative Care Medications, click here. Please note that drugs on this list can and do change periodically.

Yes, the Plan covers certain specialty medication, but a Prior Authorization (PA) may be required to determine medical necessity. Tap on the Performance Drug List button at the top of the page to search the formulary.

To determine if your specialty medication is covered on the Performance Drug Formulary, you can do the following:

• Login to your caremark.com account, hover over Plans & Benefits, and select Check Drug Cost & Coverage
• By calling CVS Caremark Member Customer Service at 833-252-6642

The PrudentRx Solution assists members by helping them enroll in manufacturer copay assistance programs. Medications on the PrudentRx Program Drug List are included in the program and will be subject to a 30% co-insurance. However, if a member is participating in the PrudentRx Solution, which includes enrollment in an available manufacturer copay assistance program for their specialty medication, the member will have a $0 out-of-pocket responsibility for their prescriptions covered under the PrudentRx Solution. Visit https://local150.org/moe/save-money-on-specialty-drugs-with-prudentrx/ for more information.

Specialty medication should be filled by the CVS Caremark Specialty Pharmacy. To check specialty medication refills and the status of an order, you can do so by the following:

• Online at caremark.com
• By calling CVS Caremark Specialty Pharmacy at 1-800-237-2767

The PrudentRx Solution assists members by helping them enroll in manufacturer copay assistance programs. Medications on the PrudentRx Program Drug List are included in the program and will be subject to a 30% co-insurance. However, if a member is participating in the PrudentRx Solution, which includes enrollment in an available manufacturer copay assistance program for their specialty medication, the member will have a $0 out-of-pocket responsibility for their prescriptions covered under the PrudentRx Solution. Visit https://local150.org/moe/save-money-on-specialty-drugs-with-prudentrx/ for more information.

The PrudentRx Solution assists members by helping them enroll in manufacturer copay assistance programs. Medications on the PrudentRx Program Drug List are included in the program and will be subject to a 30% co-insurance. However, if a member is participating in the PrudentRx Solution, which includes enrollment in an available manufacturer copay assistance program for their specialty medication, the member will have a $0 out-of-pocket responsibility for their prescriptions covered under the PrudentRx Solution. Visit https://local150.org/moe/save-money-on-specialty-drugs-with-prudentrx/ for more information.

Please click here to review the compounded medication coverage guidelines.

Yes.  You can get your flu shot and other routine vaccines that prevent illnesses like tetanus, pneumonia and shingles.  Routine vaccines are available on most plans and can help you and your family maintain better overall health.

Some vaccines are covered at no-cost, and others are covered at a standard copay based on their tier placement.

To view the current list of Preventative Care vaccines available at no-cost (active-plan only), click here. If you don’t see your vaccine listed on the Preventative Care list, you may check formulary coverage by the following:

• Login to your caremark.com account, hover over Plans & Benefits, and select Check Drug Cost & Coverage
• By calling CVS Caremark Member Customer Service at 833-252-6642