About CVS Caremark
CVS Caremark works with the EUTF to provide prescription drug plan options for you and your family. Read more about your plan options, formulary, pharmacy network, and utilization management below.
Plan Options
Review a summary of your prescription drug plan.
EUTF
- Actives (effective 7/1/2026)
- Actives (effective 7/1/2025)
- Pre-65 Retirees (effective 1/1/2026)
- Medicare Retirees
For EUTF actives and non-Medicare retirees, prescriptions for new maintenance medications are limited to one initial fill plus two refills before a 90-day supply is required.
HSTA VB
Maintenance medications: For EUTF actives and non-Medicare retirees, prescriptions for new maintenance medications are limited to one initial fill plus two refills before a 90-day supply is required.
Specialty medications: Specialty medications for complex chronic conditions require prior authorization and can be covered under either the EUTF HMSA medical plan or CVS prescription drug plan. Your benefit depends on the medication prescribed, where the medication is dispensed, and plan design. More information can be found in the Specialty Drug Benefit flyer.
Formulary
Medications are categorized into generic, preferred brand-name, non-preferred brand-name, and excluded drugs, with generics and specialty biosimilars being the most cost-effective option. Use the Check Drug Cost tool on Caremark.com or the CVS Caremark mobile app to see how your medication is covered in real time.
EUTF
The EUTF actives and non-Medicare retirees share the same non-specialty formulary, the Basic Control Formulary, and specialty formulary, the Advanced Control Specialty Formulary.
HSTA VB
The HSTA VB actives and non-Medicare retirees share the same non-specialty formulary, the Standard Opt Out Formulary, and does not have a separate specialty formulary.
Pharmacy Network
The CVS Caremark Pharmacy Network features more than 200 pharmacies statewide and more the 68,000 pharmacies nationwide, including major retailers and local pharmacies. Discover which pharmacies will accept your coverage with our Pharmacy Locator.
Retail 90 pharmacies: Save when filling a maintenance prescription at a Retail 90 pharmacy, where a member pays two times the 30-day copay for a 90-day supply. Retail 90 pharmacies include CVS, Costco, Safeway, Sam’s Club, Times, Walgreens, and Walmart pharmacies.
Mail pharmacy: The CVS Caremark Mail Pharmacy on Oahu allows members to order maintenance medications with no shipping fees and delivery within 2-3 days, offering a cost advantage over some retail home delivery options. Copays are two times the 30-day copay, offering you savings when ordering via mail. If you are also enrolled in a non-EUTF prescription drug plan, there is no coordination of benefits at CVS Mail. You can sign up for mail order through Caremark.com or the CVS Caremark mobile app, calling CVS Caremark at 1-855-801-8263, having your doctor submit your prescription to CVS Caremark Mail Service Pharmacy, or using this mail order form.
Specialty pharmacies: For assistance with ordering specialty prescriptions or to locate a specialty pharmacy, call 1-855-801-8263. For assistance with ordering from CVS Specialty, call 1-800-896-1464. For coverage of non-preferred specialty medications, have your physician call 1-808-254-4414.
Out-of-network pharmacies: Filling prescriptions at out-of-network pharmacies requires upfront payment of the full cost of the drug, with limited reimbursement. Paper claims must be submitted to CVS Caremark within one year from the date of purchase.
Utilization Management
The plan employs clinical guidelines including quantity limits, prior authorization, specialty guideline management, and generic step therapy to ensure safe, effective, and cost-efficient medication use.
- Quantity Limits: Ensure participants receive the medication in the quantity considered safe by the Food and Drug Administration (FDA), medical studies, and input, review, and approval from the CVS Caremark National Pharmacy and Therapeutics (P&T) Committee.
- Prior Authorization (PA): Clinical PA is a pre-approval process to ensure that certain therapy treatments or supplies are medically necessary before they are covered by the plan.
- Specialty Guideline Management (SGM): SGM uses evidence-based care plans and medication management outreach programs to help participants use these complex medications properly. All specialty medications require prior authorization. Physicians may call SGM at 1-808-254-4414 to obtain prior authorization.
- Generic Step Therapy Program (GSTP): Generic medications are an affordable and effective alternative to brand medications. For certain brand medications, GSTP requires that you try generic drug treatment(s) prior to the use of a brand drug.
- Dispensed as Written (DAW) Program: The DAW Program promotes the use of a generic equivalent medication, when available, in place of the associated brand-name medication. The standard generic copayment will apply. However, if a participant or their physician chooses to use a brand medication rather than the generic equivalent, then the copayment becomes the standard generic copayment plus the difference in the cost of the generic and brand medication.
Questions?
Read the Frequently Asked Questions or contact Customer Care toll-free at 1-855-801-8263 24 hours a day, seven days a week.
Glossary
Biosimilar medication: Biosimilars are alternatives to FDA-approved biologics that are used to treat serious and complex conditions. They have no clinically meaningful differences in safety and effectiveness compared to the original biologic but cost significantly less.
Formulary: This is your plan’s list of covered prescription medications, based on factors including clinical effectiveness, safety, and cost. This list is updated quarterly and promotes the use of generic or preferred brand-name medications when possible.
Generic medication: Generic medications contain the same or similar active ingredients as their brand-name counterparts but typically cost less. The U.S. Food and Drug Administration (FDA) requires generics to be as safe and effective as their brand-name counterparts.
Generic Step Therapy Program: The Generic Step Therapy Program encourages EUTF active employees and non-Medicare retirees to try generic medications before brand-name alternatives for certain conditions. You may need to try a generic treatment first before your plan covers the brand version of the same medication.
Maintenance medication: Maintenance or long-term medications are usually filled in a 90-day supply and are taken for an extended period. They’re used to treat chronic conditions like high blood pressure, diabetes, or high cholesterol. For EUTF members, new maintenance medications are limited to one initial fill plus two refills before requiring a 90-day supply. You’ll pay the lowest copay for a 90-day supply at participating Retail 90 or CVS Caremark Mail Pharmacy locations.
Prior Authorization: A pre-approval process required for certain medications to ensure they are medically necessary before your plan provides coverage. Your doctor must request approval before you can fill the prescription. Your doctor can call 1-808-254-4414 to request approval or submit a medical exception request.
Quantity Limitations: Quantity Limitations are restrictions on the amount of medication you can receive at one time, based on FDA guidelines and medical studies to ensure safe usage.
Retail 90: A network of participating pharmacies where EUTF members can get 90-day supplies at a discounted rate. You’ll pay two times your 30-day copay for a 90-day supply, which offers savings compared to monthly refills.
Short-term medication: Short-term medications, also called immediate or acute medications, are filled in up to 30-day supplies. They’re used for conditions that need immediate treatment like coughs, colds, flu, and infections. You can fill these prescriptions at any pharmacy in your plan’s retail network.
Specialty Guideline Management (SGM): SGM uses evidence-based care plans and medication management programs to help you properly use complex specialty medications. All specialty medications require prior authorization through this program.
Specialty medication: Specialty medications treat complex chronic conditions or genetic disorders like cancer, multiple sclerosis, growth hormone disorders, and immune deficiencies. They can be injectable, IV infused, oral, or inhaled. Specialty medications typically require special storage and handling and cost more than standard medications.
