Retail pharmacy

Medications covered under the pharmacy benefit are typically those that can be self-administered by the patient, such as oral tablets and capsules, topical creams and lotions.

Depending on the prescription, the member may need prior authorization. When a Prior Authorization is needed for a prescription, the health care provider will need to contact the CVS Caremark® Prior Authorization Department to answer criteria questions to determine coverage.

Prior Authorization

• To complete a prior authorization, please complete the Prior Authorization Form for Prescription Drugs and submit it by fax as indicated on the form.
• To understand which medications require approval please see the Metallic Prior Authorization Medication List (machine readable)
• To view clinical criteria please see Prior Authorization, Step Therapy, and Exception Criteria

Please note: Not all medications require prior authorization. You may contact customer service to determine what medications require prior authorization.