CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager for all three PPO plans: The Consumer-Directed Health Plan (CDHP) (85/15), Enhanced 80/20 Plan, and Traditional 70/30 Plan. Members should also note that this change does NOT mean members will have to go to a CVS pharmacy location for their prescriptions. CVS Caremark has a broad pharmacy network, which can be found using the Pharmacy Locator Tool.
Under all three health plans, the formulary, or drug list, for prescription drugs is moving from an open formulary to a closed formulary. Under a closed formulary, certain drugs are not covered. Members who are currently taking a drug that will not be covered beginning in 2017 will receive information regarding their prescription. Please note that, beginning January 1, 2017, there will be an exception process available to providers who believe that, based on medical necessity, it is in the member’s best interest to remain on the non-covered drug(s).
2017 Pharmacy Resources
In addition, members have access to the following drug lookup tools to compare costs for various drugs covered under the plan. Please note: If a drug will not be covered by the State Health Plan effective January 1, 2017, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”
In December, members will receive more information from CVS Caremark regarding their prescription drug coverage and the new programs and tools available. Members will also receive a new member ID card from Blue Cross and Blue Shield of North Carolina (BCBSNC). This is the card that members MUST start using as of January 1, 2017. The old card will not work at the pharmacy or provider’s office.
CVS Caremark Customer Service can be reached by calling 888-321-3124.