Information for health care professionals

CVS Caremark helps more than 100 million members get the medications they need by working with their plan sponsors to provide cost effective, comprehensive prescription benefit plans. We offer the convenience of a nationwide network of more than 68,000 pharmacies and the option of Rx Delivery by Mail through CVS Caremark Mail Service Pharmacy.

Rx Delivery by Mail is a convenient and cost-effective way for your patients to fill up to a 90-day supply of eligible long-term medications with no-cost shipping. With most prescription plans, members save money when they fill by mail.

Because it takes 7 to 10 business days to process a mail service prescription, you may wish to write an additional 30-day prescription that your patient can fill at retail pharmacy right away. Mail service prescriptions are typically written for up to a 90-day supply with three refills.

RxSavingsPlus provides eligible participants with savings of up to 80% on generic drugs and up to 40% on brand name drugs* at 65,000 participating pharmacies nationwide. Participants without health benefits can also save at MinuteClinic, with up to 15% off health services or screenings. It’s available to patients without prescription coverage or to patients taking medications that are not covered by their prescription plan. For more information, visit RxSavingsPlus.com or call 1-877-673-3688 TTY: 711.

*Average savings of 55% for generics and 24% for brands.

If a member’s eligibility information is incorrect and a provider submits a claim using the correct information, the claim will reject. In most cases, we can assist the provider at the point of service. Please advise your customers that they should inform their plan sponsors of any incorrect information and remind them that claims will continue to reject until it is corrected.

The identification number can be found on the member’s ID card. The Help Desk is not able to provide identification numbers.

The RXGRP number and other data can be found on the member’s ID card. Please be sure to check both sides of the card for the necessary information.

Yes. If there is an RXPCN number on the member’s ID card it must be submitted exactly as it appears on the card. If there is no RXPCN, submit the default number according to the Banking Identification Number (RXBIN) listed in the appropriate Payer Sheet.

Submit the claim through the claims system to receive the adjudicated response, which will include the amount owed by the member, as well as information on eligibility, plan coverage, pricing, and applicable clinical programs and services. The Help Desk is not able to provide this information.

Many plan sponsors allow members to receive an early refill for vacation. Submit the claim as usual and contact the Help Desk for coverage verification if the claim rejects. If the plan sponsor allows vacation supplies, the representative will provide a prior authorization code.

Providers should note the adjudication response, which typically includes online re-transmission instructions or the appropriate contact information.

Submit a claim through the claims system to receive an adjudicated response, which will include messaging about plan coverage. The Help Desk cannot provide this information.

The Help Desk will help providers determine which data fields should be used for specific data whenever possible. Because there are many different types of software, however, representatives may not be familiar with your system setup. Providers should consult their software vendor or chain headquarters for technical assistance.

Press 0 at any time during the call to connect with a representative.

Unless otherwise specified, use RXBIN 004336. In most cases, the RXBIN is on the member’s ID card.

Downloadable drug lists and guides

View and download standard and specialty drug lists, prescribing guides and other formulary information.

Please note that custom drug lists are not included here.

Members should register or sign in at Caremark.com to check drug costs and coverage.

For a general overview, explore these links:

• CVS Caremark Performance Drug List - Standard Control (PDF)
• CVS Caremark Performance Drug List - Standard Opt Out (PDF)
• Prescribing Guide - Standard Control PDF)
• Prescribing Guide – Standard Opt-Out (PDF)
• CVS Specialty Drug List (PDF)
• Site of Care/Drug Benefit Alignment Specialty Drug List (PDF)
• White Paper: Formulary Development and Management at CVS Caremark (PDF)

View and download the CVS Caremark Opioid Quantity Limits Pharmacy Reference Guide (PDF)

• 835 Pharmacy Payment Setup/Change Form (PDF)
• TrOOP Excluded Entity Patient Pay Amount Adjustment Form (PDF)
• MAC Portal – Access Appeal Process (PDF)
• Pharmacy MAC List Request (PDF)
• Pharmacy Portal Web Access

Request enrollment in CVS Caremark Med D networks online.

• Start the enrollment process

Pharmacists and pharmacy managers can complete the pre-enrollment questionnaire online. This is the first step to requesting enrollment in CVS Caremark pharmacy networks.

• Complete pre-enrollment questionnaire

Access the pharmacy change form, the pharmacy provider question form, FAQs, and client-reported pharmacy updates.

• Go to enrollment self service

• Blue Shield of California MAC List Request Form (PDF)
• State of Connecticut Maintenance Drug Network Process (PDF)
• State of Connecticut Maintenance Drug Enrollment Information
• Florida Informed Consent Form (PDF)
• Georgia NADAC Reference Reports
• Kentucky Employees’ Health Plan Extended Days Supply Network Information
• MAC Price Inquiry Process Guide for Puerto Rico (PDF)
• Tennessee Professional Dispensing Fee for Low Volume Pharmacies Survey
• MVP Health Care Vermont Extended Days Supply Network Information
• Vermont MAC List Request (PDF)

The following options are available for your training needs.

• Provider Critical Incident Training

Please select from one of the following options for your training needs.

• Provider Training for Molina Healthcare
• Molina Healthcare Provider Manual Addendu (PDF)
• Provider Training for Aetna Better Health
• Aetna Better Health Provider Manual Addendum (PDF)
• Carelon Wellpoint Provider Manual Addendum (PDF)

View and download the CVS Health Code of Conduct for colleagues and business partners.

• View the Code of Conduct (PDF)

View and download Medicare Parts C and D General Compliance Training Course 

• View Medicare Parts C and D General Compliance Training (PDF)

View and download Combating Medicare Parts C and D Fraud, Waste, and Abuse Web-Based Training Course

• View CMS Combating FWA Training (PDF)

Log in and complete the online Standard Re-Credentialing form.

• Go to the Standard Re-Credentialing form

Log in and complete the online ACA 42 CFR 455 Re-Credentialing form.

• Go to the ACA 42 CFR 455 Re-Credentialing form

Complete the State of New York Americans with Disabilities Act Attestation online.

• Go to the State of NY ADA Attestation form

View and download the Medicare Primary Payer Sheet.

• Medicare Primary Payer Sheet (PDF)

View and download the Medicaid Primary Payer Sheet.

• Medicaid Primary Payer Sheet (PDF)

View and download the Commercial Primary Payer Sheet.

• Commercial Primary Payer Sheet (PDF)

View and download the payer sheets based on the applicable supplemental plan.

Supplemental Plan: Medicaid

• Medicaid COB – OPAP (PDF)
• Medicaid COB – OPPR (PDF)
   

Supplemental Plan: Commercial

• Supplemental to MEDD – OPAP (PDF)
• Supplemental to MEDD – OPPR (PDF)
   

Supplemental Plan: ADAP/SPAP

• MEDD ADAP/SPAP – OPPR (PDF)

View and download the payer sheets based on the applicable supplemental plan.

Supplemental Plan: Commercial

• Commercial COB – OPAP (PDF)
• Commercial COB – OPPR (PDF)

View and download the payer sheets based on the applicable supplemental plan.

Supplemental Plan: Med D

• Medicare as Secondary Payer Sheet (PDF)
   

Supplemental Plan: Medicaid

• Medicaid COB – OPAP (PDF)
• Medicaid COB – OPPR (PDF)
  
  

Supplemental Plan Commercial:

• Commercial COB – OPAP (PDF)
• Commercial COB – OPPR (PDF)

View and download the Pharmacy Reject Code Reference Payer Sheet.

• Pharmacy Reject Code Reference Payer Sheet (PDF)