Value Formulary: Medicines with Clinical Requirements

  • Medicines with Clinical Requirements

    Value Formulary has clinical requirements for certain plan medicines. The requirements include:

    •  Prior Authorization (PA): This means that your doctor has to contact CVS/caremark and confirm that a specific medicine meets plan guidelines for covering your condition
    • Step Therapy with Post-Step Prior Authorization (ST, PA):
      This means that:
      • You have to try a plan medicine before being able to able to take a higher-cost medicine
      • If you have a unique medical situation where the plan medicine doesn’t work well for you, your doctor must contact CVS/caremark and confirm that a specific medicine is clinically necessary for your condition
    • Quantity Limit (QL): This means that the plan limits the amount of a specific medicine that you can fill in a 30-day or 90-day period
    • Quantity Limit with Post-Limit PA (QL, PA): This means that:
      • The plan limits the amount of a specific medicine in a 30-day or 90-day period
      • If you have a unique medical situation that requires you to take an amount larger than the limit, your doctor can contact CVS/caremark and confirm that a larger amount of medicine is clinically necessary for your condition

    Below is a list of the medicines with these requirements. Ask your doctor to consider these requirements if he or she writes a prescription for one of these medicines.


    Value Formulary


    Value Formulary Tiered


    Value Formulary Narrow


    New to Caremark.com?

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