pharmacy

pharmacy

Formulary

See www.bcbst-medicare.com for the electronic formulary

Coverage Decisions

Drug exceptions include requests for nonformulary, cost tiering and drug coverage. To request an exception please mail or fax the written statement supporting the request to:

Write:
CVS Caremark
Attn: Appeals Department
MC109
P.O. Box 52000
Phoenix, AZ 85072-2000

Fax:
1-866-884-9475

The provider’s statement must indicate that the requested drug is medically necessary for treating the member’s condition because none of the drugs we cover would be as effective as the requested drug or would have adverse effects. If the exception involves a prior authorization, quantity limit, or other limit we have placed on that drug, the doctor’s statement must indicate that the prior authorization, or limit, would not be appropriate given the member’s condition or would have adverse effects for you.

Prior Authorizations

For drugs that require a Prior Authorization (drugs that require a Prior Authorization before covered can also include drugs with quantity limits and step therapy), please complete the appropriate form and mail or fax back to:

Write:
CVS Caremark
Attn: Prior Authorization Department
1300 E. Campbell Road
Richardson, TX 75081

Fax:
1-888-836-0730

To download a Prior Authorization form, click here.

If no specific drug form is listed or you would like to send an inquiry for appropriate form, please complete the Clinical Prior Authorization Criteria Request Form and fax to the Prior Authorization Department at 1-888-836-0730.

Appeals

If your request is denied, you have the right to appeal by asking for a review of the prior decision. You must request this appeal within 60 calendar days from the date of our first decision. For expedited requests please contact us by telephone or fax.

Write:
CVS Caremark
Attn: Appeals Department
MC109
P.O. Box 52000
Phoenix, AZ 85072-2000

Fax: 866-884-9475
Phone: 866-249-6167
TTY:   866-236-1069

BlueAccess

What is BlueAccess?
BlueAccess enables you to view up-to-date policy and claim information in a secure online environment.

Page Modified:May 21, 2012