For some medications, you may be required to first try clinically appropriate generic and preferred brand alternatives when available. This process is known as “step therapy,” and your pharmacy will notify you if your prescribed medication requires it. The pharmacist will receive a message from CVS/caremark letting him or her know which prescription alternatives to offer you.
Here’s how it works:
If CVS/caremark denies your request for a step therapy exception, you can purchase the drug at your own expense. You or your doctor may also file an appeal for a denied medication. For additional information, call CVS/caremark at 1-866-889-0471. The costs for non-covered medications do not apply to your deductible or coinsurance. PCA funds may not be used for reimbursement.
Questions about your benefits? Visit the Contact Us page for contact information on each vendor.