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 CVS retail pharmacy or 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 must be filled at a CVS retail pharmacy or through the CVS Caremark Mail Service Pharmacy for a 90-day supply. 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.

• Let your physician know if you would like to use a CVS retail pharmacy or the CVS Caremark Mail Service Pharmacy so they can accurately submit your prescriptions.
• 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 1/1/2025 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

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

Prescription Drug Program compounded drug guidelines are as follows:

• Compounded drugs will be covered if at least one of the ingredients is covered through the plan
• If the cost of the compounded exceeds $300, a Prior Authorization (PA) is required. If your PA request is denied, you are responsible for 100% of the cost of the medication.
• Compounded drugs must be filled through an in-network pharmacy. To locate an in-network compounding pharmacy, you can do the following:
  • Login to your caremark.com account, hover over Plans & Benefits, and select Pharmacy Locator
  • By calling CVS Caremark Member Customer Service at 833-252-6642
• Compounded drugs should be billed through the Prescription Drug Program billing information located on your Midwest Operating Engineers vendor ID card. If the in-network pharmacy you are filling your compounded drug at does not bill insurance, ask the pharmacy to give you a completed “Universal Claim Form for a Compounded Medication”. 
  • In this instance only, you can submit the completed Universal Claim Form for a
    Compounded Medication along with the register receipt to the Pharmacy Benefit
    Department for consideration of reimbursement.
  • This documentation can be mailed to the following address:

Attn: Pharmacy Benefit Department
6150 Joliet Rd.
Countryside, IL 60525

Please note that if your compounded drug does not meet the guidelines outlined above, it will not be covered by the Prescription Drug Program. If you choose to pay out-of-pocket, you are responsible for 100% of the cost of the medication, and no reimbursement is allowed.

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, 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