Skip to main content
537277550

Value Formulary

CVS Caremark High-Value Prescription Benefit Plans

About CVS Caremark

At CVS Caremark, our goal is to help you take care of your health. We realize the medications you need to do so can be costly. With Value Formulary plans you can have medications to treat your condition and may save you money too.

About Formularies

What is a formulary?

A formulary is a list of medications that are included on a prescription benefit plan. The plan will cover the medicines that are on this list, provided they are being used appropriately.

What are Value Formulary plans?

There are two versions of Value Formulary: Value Formulary and Value Formulary Tiered. Read the descriptions below to find out which version your plan has.

Value Formulary

This version covers generic medications and listed brand medications. Plans of this type do not cover unlisted brands.

Example: For high cholesterol, the plan covers generic medications (such as atorvastatin), but does not cover Crestor®.

What This Means for You: Ask your doctor to write a prescription generic or listed brand prescription drug, if your current prescription is for an unlisted brand. This way the drug will be covered at your pharmacy, and will help you avoid paying more for your prescription.

Value Formulary Tiered

This version covers generic medications and listed brand medications. VF Tiered plans cover unlisted brands, but at a higher cost to you. You may pay up to the full cost of the unlisted brands to fill these prescriptions.

Example: For high cholesterol, the plan covers generic medications (such as atorvastatin), and covers Crestor® at a higher cost to you.

What This Means for You: Ask your doctor to write a prescription for a generic or listed brand prescription drug, if your current prescription is for an unlisted brand. This will help you avoid paying more for your prescription.

What makes a prescription benefit plan “high value”?

A plan is “high value” because:

  • Many medications included on the plan provide the same health benefits as more expensive options, but may cost up to 80% less**
  • Medications  that cost more, but may not work better than lower-cost options, are not included or are included at up to the full cost, depending on your plan*
  • It can help you and your doctor choose a lower-cost, effective option to treat your health condition

What does having a Value Formulary plan mean for you?

In many cases, having a Value Formulary plan means you will pay less out-of-pocket costs for plan medications than you did with your previous plan.† You may also have lower premiums each pay period, depending on your plan sponsor. With a Value Formulary plan, you will have access to the medications in every therapeutic class, and may even pay less for them.‡

Non-listed medications

The Value Formulary includes medications that have health benefits and could help you save money. It does not include medications that cost more and may not work better than lower-cost options. You may be required to pay up to the full cost of these medications, depending on your plan.*

Certain brand medications are not part of the Value Formulary for some of the most common short-term and long-term conditions. This list also provides lower-cost plan medications for these conditions. Ask your doctor to consider these medications instead of higher-cost brand medications.

Non-listed medications list

* The plan's medication list covers all disease states. Life-style-related treatments (i.e., anti-obesity, cosmetic, erectile dysfunction and fertility agents) may not be included or may be included at a higher cost. Plan is limited to generic medications and some brand names when a generic is not available in the class. Medications that cost more but may not work better may be offered to members at up to the full-cost, depending on their plan. Coverage may vary, please consult your plan for further information.

Medications with clinical requirements

Value Formulary has clinical requirements for certain plan medications.

Medications with clinical requirements

 

Still have questions about Value Formulary plans?

Member Frequently Asked Questions

 

About generics

Today, most prescription drug classes include several options. Some are higher-cost brand-name drugs and others are lower-cost generic options. Choosing a generic medication can save you money each time you fill your prescription while still safely and effectively treating your condition.

It’s a good idea to ask about generic options every time your doctor prescribes a new medication, and talk to your pharmacist about generics each time you fill a prescription.

New to Caremark?

Register on Caremark.com or log in to learn more about your plan and how we can help you continue on your path to better health.

 

For Providers

Prescribing providers can request a tiering exemption for a patient.

Tiering Exception Form