Your drug coverage

Your drug formulary is the list of medicines covered by your plan. Use the drug search tool below to search by name and see any notes, like if a drug needs approval or has limits.

Covered drugs are grouped by cost tiers. Generic drugs usually cost less than brand or specialty drugs. Your copay or coinsurance depends on the tier.

The formulary can change each year. Updates start on January 1. They are shown on the formulary changes grid. You can also find the full drug formulary on the forms and documents page.

Prescriptions are covered at in-network pharmacies. Out-of-network coverage may be limited to emergencies or urgent needs. If you have trouble at the pharmacy, contact us for help.

How the drug formulary works

Members get their medicine from any in-network pharmacy. Use the Pharmacy Locator to find a location in your service area. You can look up covered medicine using the online drug formulary and drug search tool below. We can mail many long-term medicines to members, that usually arrive within 10 days. Members can order by mail, by calling the FastStart number, or by having their doctor send in the prescription.

View your state’s drug formulary.

• Your cost depends on the drug and your plan benefits.
• Your plan has a network of pharmacies where you may have your prescriptions filled. Please refer to “Find a Pharmacy” to see in-network pharmacies near you. Outside your service area, drugs are covered for emergencies only.
• Your plan has a network of Mail Order pharmacies that can process and dispense up to 90 days' supply of eligible medications.
• A 90-day supply may cost three times your one-month copay or coinsurance.
• Your plan’s network also offers 90-day fill at network retail pharmacies. If you are looking for retail pharmacies that participate in the 90-day fill at retail program, participating pharmacies will show “90-day Supply Available” in the details of your search results.

To start mail-order service, here’s what you need to do:

1. Call CVS Caremark FastStart at (800) 875-0867 and provide your member ID number, prescription name, your doctor’s name and phone number and your mailing address.
2. Ask your doctor to send an electronic prescription or call (800) 378-5697 with your member ID number, date of birth and mailing address.
3. Complete and send the mail service order form.  

• You may also use Kroger Postal Prescription Services (PPSRX) by calling (800) 552-6694 or visiting ppsrx.com for additional mail order options.

If you need Specialty medications

Specialty medications require special handling, complex counseling or monitoring, limited distribution, or other specialty pharmacy requirements. Specialty medications are placed in the Specialty tier on the drug formulary. To start specialty medication service, please contact the CVS Pharmacy Help Desk at (888) 407-6425.