Pharmacy Frequently Asked Questions
Below are some helpful links, documents and searchable tools to help you understand your pharmacy benefit.
If your prescription is not listed on our formulary, contact Member Services (844-786-6762, 24 hours a day, 7 days a week; TTY: 711) to be sure it is not covered. See How to Request a Coverage Determination for more information.
Part B covers home blood sugar (glucose) monitors and supplies you use with the equipment, including blood sugar test strips, lancet devices and lancets.
Blood Glucose Meter and Test Strips
One Touch by Lifescan is the preferred covered blood glucose meter and test strips for CareFirst Blue-Cross BlueShield Advantage DualPrime members. This means this is the only brand accessible at a network pharmacy. There are no preferred lancets products. However, coverage test strips and lancets in network pharmacies depends on the quantity and whether you are using insulin (see below).
Product
Coverage Information
Getting your medication
Test Strips
OneTouch Test Strips within coverage limit (e.g., OneTouch Ultra® test strips)
Allowed Test Strip Coverage
- 100 test strips for members with diabetes who are not using insulin
- 300 test strips for members with diabetes who are us-ing insulin every 90 days
Accessible at a network pharmacy
OneTouch Test Strips over the “Allowed Coverage”
Over “Allowed Coverage”
- Not accessible at a network pharmacy
- Organization Determination through the Utilization Manage-ment (UM) department is required
- Your provider may contact our Part C Member Services and Prior Authorizations
Other test strip brands (e.g., Accu-Chek Test Strips)
Other test strip brands are not covered (regardless of quantity)
- Not accessible at a network pharmacy
- Organization Determination through the Utilization Manage-ment (UM) department is required
- Your provider may contact our Part C Member Services and Prior Authorizations
Lancets
All lancet brands within coverage limit
Allowed Lancet Coverage
- 100 lancets for members with diabetes who are not using insulin
- 300 lancets for members with diabetes who are using insulin every 90 days
Accessible at a network pharmacy
All lancet brands over the “Allowed Coverage”
Over “Allowed Coverage”
- Not accessible at a network phar-macy
- Organization Determination through the Utilization Manage-ment (UM) department is required.
- Your provider may contact our Part C Member Services and Prior Authorizations
Please speak with your provider to see if test strips and/or lancets over these quantities are needed to manage your diabetes. Your provider may contact us directly to request an Organization Determination.
Yes. Members can get several products at $0 copay, such as:
- Dexcom G5 Continuous Glucose Monitor
- Dexcom G6 Continuous Glucose Monitor
- Dexcom G7 Continuous Glucose Monitor
- FreeStyle Libre Continuous Glucose Monitor
ScriptSync is a service that coordinates your refill prescriptions so you can pick them up together at your CVS Pharmacy.
- Which of my prescriptions are eligible for ScriptSync?
- Your regular prescriptions (not including controlled substances) that are filled at the same CVS Pharmacy. If you have questions about prescription eligibility, call or visit your pharmacy.
- How can I set up for ScriptSync?
- You can enroll online via MyHealth Portal or work with your CVS pharmacy team to find a convenient pickup date. We'll refill your prescriptions on a 30- or 90-day schedule and let you know when they're ready. You can add or remove prescriptions from ScriptSync online or at the pharmacy. For more information on the program, please call us at the number on your member ID card.
- Can I change my ScriptSync pickup date?
- Your CVS Pharmacy team will suggest your first pickup date. Based on the date you pick up your ScriptSync order, your prescriptions will be refilled on a recurring 30- or 90-day schedule. After you've picked up your first ScriptSync order, you can change the date online or with help from your pharmacy team.
CareFirst Advantage DualPrime has a nationwide network of pharmacies, so chances are there's one near you! CareFirst partners with CVS Health—our pharmacy benefits manager—to find pharmacies that equal or exceed the Center for Medicare & Medicaid Services (CMS) requirements for pharmacy access in your area. To find a participating pharmacy near you, use the Pharmacy Locator Tool or search our downloadable Pharmacy Directory below.
Since the network can change from year to year, accessing the Pharmacy Locator Tool is a great way to keep current on all the in-network pharmacies. You can use this Pharmacy Locator tool to locate a network pharmacy or to determine if your pharmacy is in the network, or you can call our Medicare Part D Member Services at 844-786-6762, 24 hours a day, 7 days a week (TTY: 711).
If you would like to be mailed a hard copy of the pharmacy directory or need help finding a network pharmacy, please call member services at 844-786-6762 (TTY: 711).
Download 2024 Pharmacy Directory (English)
Download 2024 Pharmacy Directory (Spanish)
We require you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from CareFirst before you fill certain prescriptions. If you don’t get approval, the drug may not be covered.
In some cases, we require you to first try certain drugs to treat your medical condition before we’ll cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.
For certain drugs, we limit the amount that you can have each time you fill your prescription.
CVS Caremark Mail Service Pharmacy can deliver 90-day supplies of medications you take regularly to your door. It’s a safe and secure way to get your Rx – you’ll probably save money too. There are three ways to get started:
- Ask your doctor to send an electronic prescription to CVS Caremark Mail Service Pharmacy. This is the easiest way to get started – we will process and ship your order in 10 business days.
- Fill out a mail service request form and mail it with your 90-day prescription.
- Call the pharmacy number on your member ID card for live help getting set up
Yes, mail order prescriptions will generally transfer over to the new plan. We recommend you call the pharmacy number on your member ID card to confirm your mail order transferred to the new plan. CVS Caremark mail order will have the ID information when we receive eligibility, and if any mail order has open refills, they will be transferred to the new ID profile. However, the formulary coverage may change, and the prescription may no longer have refills, therefore, you should call pharmacy number on your member ID card regarding the new coverage to get a better understanding on the impact.
For refills of your drugs, please contact your pharmacy 10- 15 days before your current prescription will run out to make sure your next order is shipped to you in time.
Below are some reasons why your order may be delayed:
- Severe weather may affects mail delivery
- Your medication has special restrictions, such as prior authorization
- We don’t have your payment information
- We don’t have your consent to ship the order
Please call us at the number on your member ID card to learn about options and how we can help.
No. You cannot order a refill until you have used up 75% for most drugs, 80% for opioid drugs, or 70% for topical ophthalmic drugs of your current shipment. For a 90-day supply, this means for most drugs you can order a refill when you have three weeks left of your current shipment.
Only certain medications are available through mail order. On your formulary drug list, the last column will be marked with NM if the medication is not available through mail order. Please check your Evidence of Coverage to verify whether your drug can be filled for a 90-day supply.
When an order contains drugs that are sensitive to cold, we look at the destination temperature. If the destination temperature is below 33 degrees Fahrenheit, we ship it via a standard shipping method, with a signature required. When an order contains drugs that require refrigeration (including insulin) the order is packaged with the appropriate mix of frozen and ambient temperature gel packs (to protect the item from freezing) in a foam cooler. CVS Caremark uses an “Electronic Packing and Shipping System” (EPSS), which develops a cold chain solution for each order based on the individual order characteristics such as destination temperatures, medication type and time in transit. It is shipped via time committed delivery services with carriers such as FedEx, UPS, or Express Mail.
Just like your local retail pharmacy, registered pharmacists are available for consultation by calling the pharmacy number on your member ID card.
Yes. You can select a different shipping address to mail your prescription order to at any time. You can call the pharmacy number on your member ID card for extra help on this.
Your mail order prescription can be shipped to a PO Box if delivery is being made by your local mail service carrier. If your package is coming through another service carrier, such as Fed Ex or UPS, your order cannot be shipped to a PO Box.
There are specific procedures to follow in the rare event your medication is lost, stolen or damaged. In these cases, we will issue another supply to you. Call the pharmacy number on your member ID card immediately if your medication is lost, stolen or damaged. Please note, there may be additional restrictions for controlled substances. Check with your doctor if you are taking a controlled substance to determine if there are restrictions.
You can request an additional supply of medication by mail order or retail by calling the pharmacy number on your member ID card for up to a 90 days’ supply. They will make certain you have the necessary supply of medication while you’re away. Please note, there may be additional restrictions for controlled substances. Check with your doctor if you are taking a controlled substance to determine if there are restrictions.
You can obtain controlled substances through the mail order; however, some do require signature upon delivery. Some controlled substances require a new prescription for each fill and have dispensing restrictions that would only allow a certain day supply vs. a 90-day supply. Check with your doctor if you are taking a controlled substance to determine if there are restrictions.
You can continue to use a retail pharmacy for your short-term prescription needs and for other non-maintenance type medications, such as antibiotics, pain relief and sleep agents. Please note: You can go to any retail pharmacy in your network to fill your prescriptions and are not required to use a CVS pharmacy.
If your e-mail address is on file with CVS Caremark, you will be notified both when your order has been received and when it’s shipped. If your order requires expedited shipping or a signature, CVS Caremark will also call you to advise when delivery is expected.