FAQs
Types of Medications
Short-term medications, also called immediate or acute medications, are usually filled up to a 30-day supply. They’re used for conditions that need to be treated right away like coughs, colds, the flu and infections. You can fill prescriptions for short-term medications at any pharmacy in your plan’s retail network.
Maintenance or long-term medications are usually filled in 90-day supplies 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, prescriptions for new maintenance medications are limited to one initial fill plus two refills before a 90-day supply is required. You’ll pay the lowest copay for a 90-day supply at a participating Retail 90 or Mail Pharmacy.
Specialty medications are used to manage complex chronic conditions or genetic disorders like cancer, multiple sclerosis, growth hormone disorders, immune deficiencies, and more. Specialty medications can be injectable or intravenously (IV) infused but also may be in an oral or inhaled form. These medications typically have special storage and handling needs, and cost more than other medications. Prior authorization is required for coverage of specialty medications under the drug plan. Your physician may call 1-808-254-4414 to obtain prior authorization or submit a medical exception request for coverage.
For assistance with specialty prescriptions or to locate a specialty network pharmacy, call 1-855-801-8263. If your doctor prescribes a specialty medication, CVS Specialty® provides special support, including 24-hour access to pharmacy services, emergency pharmacist consultation, and ongoing support and counseling. For assistance with ordering specialty prescriptions at CVS Specialty, call 1-800-896-1464. Learn more about CVS Specialty.
Biosimilars are alternatives to FDA-approved biologics that are used to treat serious and complex conditions, and have no clinically meaningful differences in safety and effectiveness but cost much less.
Formulary
This is a list of the prescription medications covered by your plan. These medications are chosen based on several factors, including clinical effectiveness, safety, and cost. This list is updated quarterly and promotes the use of preferred brand-name medications and generic medications whenever possible. Sign in at Caremark.com to see your plan’s drug list. You can use the Check Drug Cost tool on Caremark.com or on the CVS Caremark mobile app to see if a medication is covered and how much you’ll pay for it. You can also call CVS Caremark Customer Care at 1-855-801-8263 to find out if a specific medication is covered by your plan.
To save money, ask your doctor to prescribe generic or preferred brand-name medications from the CVS Caremark Drug List. Use the Check Drug Cost tool on the mobile app when you visit your doctor’s office.
Generic and biosimilar medications are an affordable option to brand-name medications. They contain the same or similar active ingredients as their brand-name counterparts and are effective in treating most health conditions but typically cost less. Generic and biosimilar medications work the same way as brand-name medications and are approved by the U.S. Food and Drug Administration (FDA) for safety and effectiveness.
The Dispensed as Written Program promotes the use of generic equivalent medications, when available, in place of brand-name counterparts. The standard generic copayment will apply. However, if you (EUTF or HSTA VB plan participant) or your physician (EUTF plan only) choose to use a brand medication rather than its generic equivalent, you’ll pay the standard generic copayment plus the difference between the cost of the generic medication and brand medication.
Coordination of Benefits
Some participants may be enrolled in prescription drug coverage in addition to the EUTF or HSTA VB plan. If this applies to you, please contact CVS Caremark Customer Care at 1-855-801-8263 to confirm if your EUTF plan is secondary. If your plan is secondary, be sure to let the pharmacy know by presenting both of your prescription drug ID cards and confirm that the pharmacy can bill all plans. Please note that there is no coordination of benefits between multiple insurance plans at CVS Caremark Mail Pharmacy and some non-participating pharmacies.
You also have the option to send in a paper claim form for reimbursement. Please note that Coordination of Benefits does not guarantee 100% coverage of your medication. All EUTF plan parameters and guidelines will still apply. Coverage under your non-EUTF drug plan does not imply coverage under the EUTF drug plan.
Utilization Management
In an ongoing effort to effectively manage the prescription drug benefit, certain medications are subject to clinical guidelines as part of the prescription benefit plan design. The drug benefit includes the following four clinical guidelines:
- Quantity Limitations – Ensures 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.
- Generic Step Therapy Program (GSTP) – The EUTF encourages the use of generic medications as an alternative to certain brand medications as an affordable and effective form of treatment for many health conditions. To promote use of generic medications, CVS Caremark has a generic step therapy program in place for all EUTF active employees and non-Medicare retirees. For certain brand drugs, GSTP may require that you try generic drug treatment(s) prior to the use of a brand drug. Please contact CVS Caremark Customer Care at 1-855-801-8263 for more information.
- Prior Authorization (PA) – Clinical prior authorization is a special 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.
Pharmacy Network
The CVS Caremark Pharmacy Network features more than 200 pharmacies in Hawaii and more than 67,000 pharmacies nationwide. The network consists of CVS and non-CVS, retail and mail, specialty and non-specialty pharmacies. To find a network pharmacy near you, use the Pharmacy Locator tool. Or, you can call Customer Care at 1-855-801-8263 (available 24 hours a day, seven days a week).
Find a network pharmacy by using the Pharmacy Locator tool or by calling CVS Customer Care at 1-855-801-8263. Call or visit your new network pharmacy and tell the pharmacist where you are currently filling your prescription. The pharmacist will contact the out-of-network pharmacy and make the transfer for you.
Yes. If you fill your prescriptions at an out-of-network pharmacy (or are unable to confirm your plan enrollment at a participating pharmacy), you will be responsible for paying the full cost of the drug at the time of purchase, and reimbursement will be limited to the eligible charge less the out-of-network copayment and coinsurance. Paper claims must be submitted to CVS Caremark within one year from the date of purchase. Download a paper claim form from Caremark.com which includes the submission requirements and address to where the form should be mailed.
CVS Caremark Mail Pharmacy
The CVS Caremark Mail Pharmacy is located on Oahu and is a convenient way for you to order your maintenance prescriptions. Your maintenance medications can be delivered to your home or a location of your choice with standard shipping at no cost to you. This differs from a retail pharmacy where home delivery fees may apply.
Choose one of three ways to transfer your prescription from a retail pharmacy to the CVS Caremark Mail Pharmacy:
- Call CVS Customer Care at toll-free 1-855-801-8263.
- Register or login to Caremark.com
- Select Prescriptions from the navigation bar.
- Select Start Rx Delivery by Mail from the drop-down menu.
- Ask your doctor to write a prescription for a “90-day supply plus refills,” if clinically appropriate, and send it to the CVS Caremark Mail Service Pharmacy. The pharmacy must fill your prescription for the exact quantity that your doctor prescribes, up to your plan design limit.
If you need to take a maintenance medication right away, ask your doctor for two prescriptions:
- The first prescription written for up to a 30-day supply to be filled at a retail pharmacy.
- The second prescription written for a 90-day supply up to three refills, if clinically appropriate, to be sent to the CVS Caremark Mail Service Pharmacy located on Oahu.
Your prescription order will be processed and mailed within five business days from the day we receive your order. You can check your order status at Caremark.com or by calling toll-free 1-855-801-8263.