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).
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.