Prescription Drug Benefits
California's Valued Trust (CVT) and our prescription benefit provider, CVS/caremark™, provide prescription drug benefits for plan participants and their eligible dependents enrolled in either a CVT high-deductible health plan (HDHP) or a preferred provider organization (PPO) plan. This page is only a summary of prescription benefits. Please refer to the Benefit Booklet for Prescription Benefits located at www.cvtrust.org/CVS-caremark-plan-documents for additional information.
Maximize Your Prescription Benefits
Excellent Retail Coverage – Designed to provide maximum geographic coverage, CVS/caremark’s comprehensive national network contains most drug store chains and other large retail merchandisers, grocery chains and independent pharmacies, providing broad national coverage and excellent access, throughout the United States, Puerto Rico, and the Virgin Islands. Your prescription should be filled at a CVS/caremark participating retail pharmacy and is dispensed with a 30 day supply. For a complete pharmacy listing in your area please visit www.caremark.com or call 1-888-354-6390.
Convenient Mail Order – Getting started with mail order is quick and easy by contacting the FastStart Program at 1-866-273-5268. A representative will contact your physician for your mail order prescriptions, all you need to provide is your ID number, mailing address, drug name, physician name and phone number. Mail order service provides the convenience of free standard shipping to your home.
Drug Coverage Overview
CVT works closely with CVS/caremark to manage drug benefits to combat rising costs for all Plan participants. The CVS/caremark pharmacy staff continually reviews drugs, products and prices on behalf of CVT. Following is a list of pharmacy programs designed to ensure you receive clinically appropriate medications at the best cost.
Maintenance Choice® Program – Maintenance Choice® offers you choice and savings when it comes to filling long-term prescriptions. A long term medication is taken regularly for chronic conditions or long-term therapy, such as asthma, diabetes, high blood pressure, arthritis or cardiovascular disease. Plan participants and their families must choose to receive 90-day supplies of their long-term medications either by mail through CVS/caremark Mail Service Pharmacy or to pick them up at a CVS Pharmacy near them. Either way the copay remains the same for both services and will be a 90 day supply which translates to a savings of one retail copay.
Saving with Generics
Just because a medicine costs more doesn’t mean it is more effective. Many lower-cost medicines like generics provide great health benefits while saving you money. Today, approximately 83% of all prescription drugs are now available in generic form. FDA approved generic medicines are often just as effective in treating your disease. To gain FDA approval, generic drugs must meet rigorous standards for safety, purity, strength, and quality.
Generic versus Brand Drugs – For any brand drug with a generic equivalent available, the pharmacy will dispense the generic. The physician or plan participant can request the branded version be dispensed, BUT the participant will pay the generic co-pay plus the cost difference between the brand and generic.
Generic Step Therapy – Generic Step Therapy is designed to help encourage evidence-based utilization of generics and low net cost brands in key therapeutic classes. It also addresses the most common step therapy challenges and includes effective member and physician outreach. If you use certain high-cost medicines before the available lower-cost options, your current prescription may not be covered and you may have to pay the full cost.
Specialty Pharmacy – CVS/caremark and its affiliates provide clinical management and distribution of injectable, biotech and other specialty drugs from their network of 43 specialty pharmacies throughout the United States and Puerto Rico. The Specialty program offers individuals personalized pharmacy care management and is assigned a pharmacist-led CareTeam who effectively manages your condition. For Specialty Services/Admissions please call 1-800-237-2767.
Prior Authorizations (PA) – In order for some prescription medications to be covered as a part of your benefit, a Prior Authorization (PA) evaluation will be conducted to determine if the medications’ prescribed use meets defined clinical criteria. Through this process, your doctor and CVS/caremark pharmacists will work together to ensure that the drug you are prescribed is the most appropriate for your condition. The CVS/caremark Prior Authorization number is 1-800-294-5979.
Quantity limits – Quantity limits are defined as the maximum number of tablets or units (i.e. injections or nasal spray bottles) covered by the plan per copayment or coinsurance amount. For more information on managed drug limitations, please call CVS/caremark Customer Service at 1-888-354-6390.
More Plan Features
- Insulin, disposable needles, syringes, lancets and test strips are available through your CVS/caremark prescription plan. Glucometers are not a covered item under the CVS/caremark prescription plan; however, CVS/caremark does offer the Diabetic Meter Program. This program offers a new, free meter every two years to eligible members; just call 1-800-588-4456 to receive your free meter.
Reduced Pharmacy Copayments.A PPO participant, spouse or domestic partner may be eligible for reduced pharmacy co-payments for certain condition-related prescriptions when enrolled or engaged with a nurse in an approved Accordant Health Management program. Contact Accordant at 1-800-948-2497 for more program information, confirm eligibility and enrollment.
Spouse or other dependent coverage. If your spouse or other dependent has prescription drug coverage under his/her own CVT group number or from another carrier, that coverage must be used first for those individuals that have this as the primary coverage. Any balances should be submitted to CVS/caremark for consideration of payment.
Stay connected to your prescription benefits
Log on to the CVS/caremark mobile site at www.caremark.com or through your Apple® or Android™ mobile app for real-time, secure access to your prescriptions and pharmacy information:
- Request mail service prescriptions
- Request a new prescription with FastStart®
- Check your order status
- Check your drug coverage and cost
- Find pharmacies in your network
- View your prescription history
The CVS/caremark website requires that you register on the site before you can use their search pharmacies tool.
CVT ValuRx Prescription Plan Coverage
The CVT ValuRx Prescription Plan is distinctive from CVT's other prescription plans in that it is heavily geared towards generic medications through the Value Formulary and has a more managed network, the Proximity Network. Learn More about this plan.
- Anthem Blue Cross PPO Member Identification (ID) Card Information (PDF)
- Blue Shield of California PPO Member Identification Card Information (PDF)
- Silverscript -Medicare Part D Prescription drug coverage provider for all eligible CVT PPO members