CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager for both PPO plans: The 80/20 Plan and 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 a closed formulary. Under a closed formulary, certain drugs are not covered. Please note that, there is 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).
2018 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, 2018, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”
CVS Caremark Customer Service can be reached by calling 888-321-3124.