Understanding CareFirst PBM Prescription Drug Plans and Coverage

CareFirst PBM offers a range of prescription drug plans to help you save money on medications. These plans are designed to provide affordable coverage for a wide variety of prescription medications.

The CareFirst PBM prescription drug plans have different levels of coverage and copays, depending on the plan you choose. Some plans have a lower copay for generic medications, while others have a lower copay for brand-name medications.

CareFirst PBM also offers a formulary, which is a list of covered medications that are divided into different tiers based on their cost. The formulary helps to ensure that you have access to the medications you need at a lower cost.

CareFirst PBM has a network of pharmacies that participate in their prescription drug plans. This network includes pharmacies like CVS, Walgreens, and Rite Aid, among others.

Explore further: Carefirst Ceo

At CareFirst PBM, pharmacy services are designed to make medication management easier and more affordable for members. CareFirst PBM has a vast network of over 70,000 pharmacies nationwide.

Members can fill their prescriptions at any of these pharmacies, which helps ensure they have access to the medications they need. CareFirst PBM's pharmacy network includes both retail and mail-order pharmacies.

CareFirst PBM also offers a 90-day supply option for certain medications, which can help reduce costs and minimize the need for frequent refills.

CVS Caremark will provide pharmacy and other services to 1.2 million CareFirst members.

The partnership between CVS Caremark and CareFirst has been renewed through 2023, allowing CareFirst to continue offering excellent pharmacy benefits to its members.

CareFirst's President and CEO, Chet Burrell, praised the partnership, stating that CVS Caremark will continue to play a key role in improving members' health through its role in key medical programs.

Accurate and complete pharmacy claims information is essential to maximizing the value of CareFirst's PCMH and TCCI programs, and CVS Caremark has proven itself capable of delivering outstanding service.

CareFirst members taking specialty medications can use CVS Specialty, which includes 24/7 access to specially trained nurses and pharmacists that provide disease management services and support.

CVS Specialty allows members to pick up specialty prescriptions at any CVS Pharmacy location or have their medications delivered.

Our pharmacy services include a formulary, which is a list of covered prescription drugs. This list is reviewed and approved by an independent national committee of physicians, pharmacists, and other healthcare professionals to ensure the drugs are safe and clinically effective.

The formulary is divided into tiers, which determine the price you pay for prescription drugs. Depending on your plan, there may be 3, 5, or another number of tiers.

Preventive drugs, like statins, aspirin, and folic acid, are available at a zero-dollar cost share if prescribed by your doctor under certain medical criteria. This applies to oral chemotherapy drugs and diabetic supplies as well.

Generic drugs, which are the same as brand-name drugs in terms of safety, strength, and quality, are generally less expensive than brand-name drugs.

Preferred brand drugs, which are chosen for their cost-effectiveness, have a higher cost share than generics but lower than non-preferred brand drugs. If a generic becomes available, the preferred brand drug may be moved to the non-preferred brand category.

Here's a breakdown of the 5-tier drug plan:

Non-preferred brand drugs often have a generic or preferred brand drug option, where your cost-share will be lower.

A Comprehensive Medication Review (CMR) program can connect you with a pharmacist who will review your medications and talk to your doctor about dosages, duration, and other pertinent issues.

You can use our Drug Search to see if your medication requires prior authorization, step therapy, or quantity limits. This will help ensure you're receiving the most appropriate medication for your condition.

Certain medications have prescription guidelines to ensure you're receiving the right treatment. If your doctor prescribes a non-preferred brand drug when a generic alternative is available, you'll pay the non-preferred brand copay or coinsurance plus the cost difference between the generic and non-preferred brand drug.

You can request an exception if you need the brand-name drug for medical necessity reasons. Your doctor can submit a brand exception request on your behalf by contacting 855-582-2022.

The Comprehensive Medication Review program is a game-changer for people taking multiple medications.

A CVS Caremark pharmacist will review your medications and talk to your doctor about dosages, duration, and any other pertinent issues.

This program can help you and your doctor determine what medications best fit your situation.

The pharmacist will work with your doctor to ensure you're getting the most effective treatment possible.

You can connect with a pharmacist through the CMR program to get a comprehensive review of your medications.

Drug Tiers can be a bit confusing, but basically, your cost share is determined by which tier a medication falls under.

Zero cost-share drugs include preventive drugs, oral chemotherapy drugs, medication-assisted treatment drugs, and diabetic supplies, which are essentially free.

Generic drugs are just as safe and effective as brand-name drugs, but they're significantly cheaper.

Preferred brand drugs are brand-name drugs that are chosen for their cost-effectiveness, and your cost share will be more than generics but less than non-preferred brand drugs.

If a generic drug becomes available, the preferred brand drug may be moved to the non-preferred brand category, so it's worth keeping an eye out for those generic options.

Non-preferred brand drugs often have a generic or preferred brand drug option where your cost share will be lower, which is always a good thing to look into.

Preferred specialty drugs are medications for complex and/or rare health conditions, and they may have a lower cost share than non-preferred specialty drugs.

Non-preferred specialty drugs often have a specialty drug option where your cost share will be lower, so it's worth exploring those alternatives.

Care Support is an essential part of CareFirst PBM's services. It's designed to help patients navigate the complex healthcare system and get the support they need.

CareFirst PBM offers a dedicated care management team that works with patients, providers, and payers to create personalized care plans.

Patients can expect proactive outreach and engagement from their care team, who will help them stay on track with their treatment plans and address any concerns they may have.

CareFirst PBM's care management team includes pharmacists, nurses, and other healthcare professionals who are trained to provide expert guidance and support.

With CareFirst PBM's care support, patients can access a wide range of resources and services, including medication therapy management, disease management, and patient education.

CareFirst PBM's care support has been shown to improve patient outcomes, reduce hospital readmissions, and lower healthcare costs.

CareFirst PBM's care support is available to patients with complex or chronic conditions, including diabetes, heart failure, and asthma.