To locate CVS Caremark network pharmacy, go to caremark.com or call (855) 271-6601.
Certain prescription drugs have special rules that affect coverage, fulfillment and/or payment. Read or click below for information on the special rules for the following drugs classes.
Below is a summarized schedule of prescription drug benefits under the Health Plan.
| Up to 30-day supplies from Participating Retail Pharmacies | Up to 90-day supplies from any local CVS Pharmacy or CVS Mail Service | |
|---|---|---|
| Deductible | There is no deductible associated with the prescription drug benefit. | |
| Allowable Quantity | Up to 30-day supply | Up to 90-day supply |
| Generic Drug Co-Payment* | $10 | $25 |
| Brand Drug Co-Payment* | $24 | $60 |
|
Lifestyle Drug Co-Payment (i.e., erectile dysfunction drugs, proton pump inhibitors and sleep aides. ) |
Greater of $40 or 50% of the cost of the medication | Greater of $60 or 50% of the cost of the medication |
If you are taking a maintenance medication (three months or more), you are allowed two 30-day fills at a retail pharmacy. After the first two fills, to avoid paying the entire cost of the medication, you will be required to obtain your medication in 90-day supplies, using one of the following two options:
For questions about the program, please call (855) 271-6601 or visit caremark.com.
For more information on maintenance medications, please refer to pages 84-85 of the March 2025 Health Plan Summary Plan Description.
You may purchase your medication at a non-network pharmacy, but you will have higher costs and will have to file a claim with CVS Caremark for reimbursement.
All Health Plan participants, beneficiaries and DGA members can now obtain the RxSavingsPlus card from CVS Caremark free of charge regardless of Health Plan coverage status. With the RxSavingsPlus card, you can save on the full cost of brand name and generic medications at more than 65,000 participating pharmacies nationwide.
A few benefits of the card include:
For more information or to sign up to receive the card, visit www.dgaplans.org/rxsavingspluscard.
Beginning April 1, 2024, all eligible fertility-related prescriptions must be filled through Carrot Rx for your eligible medications to be covered with Carrot funds. CarrotRx has partnered with Alto Pharmacy. Your medications will need to be filled directly with Alto Pharmacy and communication on the status of your prescriptions will be coming from Alto as well. When medications are received, it will state it is from Carrot Rx (powered by Alto) on the box.
If you currently receive your fertility-related medications through a pharmacy other than Carrot Rx, you will have until May 15, 2024 to transition your prescriptions to Carrot Rx. After May 15, 2024, expenses you submit from non-Carrot Rx pharmacies will be denied.
Carrot Rx offers savings of up to 40%, as well as price matching on most fertility-related medications and next-day or same-day delivery when needed. With Carrot Rx, you also get 24/7 access to certified clinicians who can answer any questions you might have about your medications.
For more information about getting your fertility-related medications with Carrot Rx, including frequently asked questions, exceptions to the Carrot Rx-only prescription policy and a step-by-step guide to ordering your prescriptions through Carrot Rx, click here to download a helpful pdf.
See the “Lifestyle Drugs” section beginning on page 86 of the March 2025 Health Plan Summary Plan Description for more information
Generic contraceptives are covered at 100% under the Health Plan’s Preventive Care Services benefit.
When you go to a pharmacy within the CVS Caremark network, you should only be responsible for your copay. Claims for covered prescriptions filled at a non-network pharmacy should be filed with CVS Caremark, the Health Plan’s prescription benefit manager, for reimbursement. If you purchase prescription medication at a non-network pharmacy:
DO NOT submit claims to the Health Plan Office.
Mail your claim directly to Blue Cross at the address below:
CVS Caremark
P.O. Box 52136
Phoenix, AZ 85072-2136
CVS Caremark will reimburse you for the amount they would have covered at the discounted rate, less the applicable co-payment amount.
