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Beneficios de farmacia

We cover a wide range of prescription and over-the-counter (OTC) medications to help keep our members as healthy as they can be.



Questions? Just call Provider Experience at 1-855-221-5656 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.


Covered medications formulary

Covered medications formulary

Prescription medications


We cover the prescription medications on the formulary without copays. If your patient needs medication, you’ll want to check the list for covered medications, step therapy requirements, quantity limits and updates. You can download the list or check it using our online search tool

PDL (PDF) Online search tool



The state updates the formulary regularly. Updates may include info about the addition and/or removal of:

  • A medicine from the PDL 
  • Prior authorization (PA) requirements 

You can find the most up-to-date PDL using our online search tool.

Diabetes prescriptions


If you need a prescription for glucose meter and test strips, Johnson & Johnson OneTouch® products are preferred. The preferred pen needles and insulin syringes are BD products.


Still not sure if we cover a specific medication? Just call 1-855-221-5656 (TTY: 711). We can check it for you. 


PDL (PDF) Online search tool

OTC medications


Members can get coverage for OTC medications on the formulary when they:


  • Meet any added requirements (for some medications)
  • Get a prescription from their provider
  • Fill their OTC prescription at a pharmacy in our network

Not sure what’s covered? Just call us at 1-855-221-5656 (TTY: 711). Be sure to have the member’s list of medications ready. We can check to see if they’re on the list.


$25 OTC benefit


Members can get $25 per month per household toward some OTC medications and supplies.


More about member pharmacy benefits

Medicamentos de especialidad

Medicamentos de especialidad

If you prescribe a specialty medication, members can fill it at any pharmacy in our network. Not all pharmacies carry these medications, so members may need to find a specialty pharmacy. Some conditions that need specialty medications include:


  • Cáncer
  • Hemophilia
  • Immune deficiency
  • Esclerosis múltiple
  • Rheumatoid arthritis

You’ll want to get PA for these medications. Fax the PA form to 844-807-8453. Or you can call 1-855-221-5656 (TTY: 711) to ask for PA. You can also include any medical records that may help with the review of your request.

More pharmacy information

Learn about everything from step therapy to prior authorization (PA).

If a member needs prior authorization (PA) for a medication, you can fill out a pharmacy PA form on their behalf. Or you can call us at 1-855-221-5656 (TTY: 711).


Pharmacy PA

When members need medication, they’ll:


  • Ask you to make sure the medication is on the formulary
  • Take their prescription to a pharmacy in our network
  • Show their plan member ID card at the pharmacy

Remind members to check with you at least five days before running out of medication. They understand that you may want to see them before prescribing refills.

Members can fill prescriptions at any pharmacy in our network. We can’t cover medications they fill at other pharmacies.


Find a pharmacy nearby

When members take maintenance medication for an ongoing health condition, they can get it by mail. We work with CVS Caremark® to provide this service at no extra cost. Each order is checked for safety. And members can speak with a pharmacist anytime on the phone. 


To get started, members will need their:


  • Plan member ID card
  • Mailing address, including ZIP code
  • Provider’s first and last name and phone number
  • List of allergies and other health conditions
  • Original prescription from their provider (if they have it)


Mail service makes it easy

Members and providers can call CVS Caremark at 1-855-271-6603 (TTY: 711), 24 hours a day, 7 days a week. They’ll explain which medications can be filled with CVS Caremark Mail Service Pharmacy. CVS Caremark will also contact you for a prescription and mail the member’s medication. Members can sign up for mail service:



Members can go to the Member Portal and sign in or register (for new users). Then, they’ll choose: Tasks, Pharmacy services, CVS and Start mail service.


With an order form

Members will ask you to write a prescription for up to a 90-day supply with up to one year of refills. Then, they can fill out a mail service order form English (PDF) | Spanish (PDF).  Or we can mail them a form. They just need to call us at 1-855-221-5656 (TTY: 711).


Members can send the form, along with their prescription, to:

CVS Caremark

PO Box 2110

Pittsburgh, PA 15230-2110 


By phone

Members can also call CVS Caremark at 1-855-271-6603 (TTY: 711). They can call 24 hours a day, 7 days a week. If they agree, CVS Caremark will call you to get a prescription.

The step therapy program requires certain first-line drugs, before approval of specific, second-line drugs. 


Certain drugs on the formulary have quantity limits. The formulary identifies these drugs with the letters “QLL.” Quantity limits are based on:


  • FDA-approved dosing levels
  • Nationally established, recognized guidelines related to each condition

Need to ask for prior authorization for step therapy or a quantity limit? Just fax the pharmacy PA form to 844-807-8453. Or you can call 1-855-221-5656 (TTY: 711) to ask for PA. You can also include any supporting medical records that may help with the review of your request.


Pharmacy PA

Need information about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332. Or visit the drug recalls page on the FDA website.

OneTouch is a trademark of LifeScan IP Holdings, LLC.

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