CVS Caremark Formulary 101: What is a Formulary?

Each year, CVS negotiates pricing with various drug manufacturers. Those negotiations ultimately result in CVS updating its formulary, which is a list of drugs that are covered under the Health Plan. With CVS Caremark’s formulary, you and your doctor can determine which medications are covered under the Health Plan so that you can make more cost-effective decisions.

Why is it important to choose drugs on the formulary?

The CVS Caremark formulary lists the medications that are covered by the Health Plan. Choosing a drug that is included in the formulary can lower your out-of-pocket costs.

The formulary also categorizes the covered drugs as brand or generic—that is, medications your doctor can prioritize prescribing when medically appropriate. The formulary may include several generic and brand name medications that treat the same condition. When a generic medication appears on the formulary along with its brand-name counterpart, the generic drug is typically the less expensive option.

How do I use the formulary?

It is good practice to refer to the formulary at www.dgaplans.org/formulary whenever your doctor prescribes a new medication. Doing so enables you to confirm that any newly prescribed medication is covered by the Health Plan.

If you ever receive a letter from CVS notifying you that a medication you are taking will no longer be covered due to a change in the formulary, the letter will include information regarding the alternative medication(s)so that you may discuss options with your doctor. If your doctor determines that the alternative medication(s) is not medically appropriate to treat your condition, your doctor can request a coverage review from CVS Caremark to determine whether or not the medication is medically necessary to receive continued coverage.

Where to find prescription drug savings

Determining if your medication is covered is one thing, but finding the lowest cost is another. Use the tools below to find the best prices for covered and non-covered medications.

• Check Your Drug Cost/Price a Drug tool: Use these tools to check prescription coverage status and compare generic and brand name prices of covered medications. With the Check Your Drug Cost tool available at caremark.com and the Price a Drug tool on the CVS Caremark app, you can learn whether a medication is covered and view alternative medications that are available at a lower cost to you.
• RxCompare: For help finding the lowest prices for covered and non-covered medications, use CVS’s Rx- Compare tool to search for discount cards available for various medications. Simply enter your zip code and the drug name to receive a price comparison list.
• www.dgaplans.org/rxsavings: For a list of ways to save on prescription drugs, visit www.dgaplans.org/rxsavings. Keep in mind that most drug savings coupons have specific criteria that might not apply to you (such as intended for use only by those who are uninsured).

  In addition, regardless of coverage status, you can get an RxSavingsPlus card from CVS Caremark free of charge to save on the full cost of brand name and generic medications at more than 65,000 participating pharmacies nationwide. Visit www.dgaplans.org/rxsavingspluscard for more information.