CVS Carmark Medication Authorization Criteria January 1, 2018

CVS Carmark Medication Authorization Criteria January 1, 2018

CVS CAREMARK CRITERIA

Starting January 1, 2018, these patients may not be able to fill their current medication at the pharmacy, based on the plan’s coverage changes.

Please visit caremark.com/highvalueplan to review the coverage details of this pharmacy benefit plan.

 

PA                                    = Prior Authorization                                    There must be a satisfied PA on file or a PA must be requested.

Please call 1-877-203-1681

 

ST                                    = Step Therapy                                                      The patient must have already satisfied the step therapy

requirements through previous medication use.

 

QL                                    = Quantity Limits                                    The medication to be dispensed must be for less than the quantity

limits restriction. No further action is necessary if the quantity dispensed for this prescription is below the limit.

 

 

QLWPA                                    = Quantity Limits With                                    The medication to be dispensed must be for less than the quantity

Prior Authorization                   limits restriction. A PA must be requested for quantities greater than the limit restriction. Please call 1-877-203-1681. No further action is necessary if the quantity dispensed for this prescription is below the limit.

 

FE                                    = Formulary Exclusion                                    Patient’s formulary does not cover the medication. You may request

A formulary exception based on medical necessity. Please call

1-877-203-1681.

 

BE                                    = Benefit Exclusion                                    Patient’s pharmacy benefit design does not cover this medication.