Making sure you have access to medications at the lowest possible cost is our priority. To help keep costs low, your plan covers a list of medications used to treat most conditions. This list is sometimes called your drug formulary. It's important to review this list with your doctor so they can try to prescribe an effective medication that's also covered by your plan.

The easiest way to see which medications are covered is to sign in to your Caremark.com account and review your plan info. You can also use our drug cost and coverage tool with your doctor to compare your options before you fill a prescription.

If your doctor still prescribes a medication that isn't covered by your plan, then you may need prior authorization. This process ensures certain criteria is met before your plan will cover your prescription. There are a few reasons why a prior authorization might be required. The medication may be unsafe when combined with other medications you're taking, used only for certain health conditions, have the potential for misuse or abuse, or an effective alternative might be available.

If your medication does require a prior authorization, you should speak with your doctor to see if an alternative is available. If not, then you or your pharmacist can ask your doctor to start a prior authorization. We'll then work with your doctor to get additional information that will help us determine if the medication should be covered. The process can take several days and depends on how complete and quickly information is provided and reviewed. If approved, you can fill your prescription. If denied, you'll receive a letter and then you can ask your doctor if there's another medication covered by your plan that may also work for you if you haven't already. Choose to pay for the medication yourself at a retail pharmacy, or you or your doctor can submit an appeal by following the steps in your letter. To learn more, visit Caremark.com.

Prior authorizations

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