On July 1, 2015, CVS/caremark will be the prescription benefit manager (PBM) for State of Illinois employees, dependents and retirees. This change in vendor only affects members enrolled in the Local Care Health Plan and the Local Consumer-Driven Health Plan, both administered by Cigna, HealthLink OAP and Coventry OAP. Plan members were mailed new prescription ID cards by CVS/caremark the week of June 22nd. Plan participants should be sure to show their new ID card to the pharmacist when they pick up their first prescription on or after July 1st. Members may request additional ID cards by calling CVS/caremark customer service at 877-232-8128 24 hours a day, 7 days a week, or beginning Wednesday, July 1st, by registering on www.caremark.com and accessing their personal account.
Note: HMO Illinois, BlueAdvantage HMO, Coventry HMO and Health Alliance HMO each have their own PBM and are not impacted by this change.
CVS/caremark has a very extensive network of pharmacies participating in their network. Your State of Illinois health plan does not require or mandate that you utilize a CVS pharmacy as there are over 68,000 participating pharmacies in the network. The CVS/caremark network includes most of the large pharmacy chains, including but not limited to, Walgreens, Wal-Mart, Target, as well as roughly 26,000 independent pharmacies across the country.
Changing to a new PBM brings along a new formulary list of drugs. Any time a formulary changes, there is a chance that a specific drug will no longer be covered, or will be covered at a higher copayment. The Department of Central Management Services has worked with CVS/caremark to institute a 90-day grace period of medications members and their dependents are currently taking that will not be covered under CVS/caremark’s formulary. This means that during the first 90 days of the new plan year beginning July 1, affected members will not experience a disruption of coverage or increase of copayment. Affected members will be notified by CVS/caremark to contact their prescribing physician to look for an alternate drug that is covered under the CVS/caremark formulary.
Beginning July 1, 2015, members should log in and register on the CVS/caremark website www.caremark.com. Registered members will have access to a list of network pharmacies, mail order claim forms, and much more. Members will also be able to utilize an interactive formulary list search tool, which will allow you to check your current prescribed drugs against the CVS/caremark formulary list.
In the interim, members can look up any drug that they or their dependent(s) are taking to see if the drug is included in the CVS/caremark formulary and the associated cost of the prescription using the ‘Formulary Look Up’ tool in the links below. If you discover your current prescribed drug will no longer be covered, you should consult your physician to see if there is an alternate drug that could be prescribed. If there is no alternate drug, your physician should complete the prior authorization process for your medication. If approved, CVS/caremark can provide an override to the formulary which will allow your drug to be covered under the plan even though it’s not on the formulary.
The Customer Care phone number for CVS/caremark is 877-232-8128. Customer service representatives will be available to answer your calls 24 hours a day, including Saturday and Sunday.