Health Benefits

5 Tips to Maximize Your Pharmacy Benefits with CVS Caremark

2 weeks ago
Pharmacist explaining a medication to a customer

CVS Caremark (CVS)—and SilverScript for Medicare members—is our new pharmacy benefits manager (PBM) for pharmacy benefits under certain health plans. For the full list of CVS-covered plans, FAQs, and more information, you can visit OptumRx Replaced by CVS on our website.

To answer common questions we’ve heard from members, here are five tips to help you maximize your pharmacy benefits.

1. Managing Prior Authorizations and Exceptions

If you’ve had a medication approved through a prior authorization with OptumRx, in most cases that approval automatically transferred to CVS or SilverScript. This authorization remains active until it expires, at which point your doctor may need to request a new one.

If you’re prescribed a medication that is not covered under the new formulary and your doctor believes you need that particular drug, they can request an exception based on medical necessity.

What you can do:

  • If you have questions about whether your prior authorization transferred, Basic (non-Medicare) members should call CVS at (833) 291-3649. Medicare members should call SilverScript at (833) 291-3648. If your prior authorization cannot be transferred, talk to your doctor about requesting a new one. You can also request that CVS or SilverScript send the required form directly to your doctor.
  • If your drug is no longer covered under the new formulary, transition fills are available through March 31, 2026. This provides time to work with your doctor to discuss a safe and effective alternative or request a medical necessity exception.
  • Basic members can call CVS to request a transition fill. For Medicare members, the transition fill is automatically applied when you refill the medication at the pharmacy. You may request multiple refills up to a maximum 90-day supply.

2. Staying On Top of Costs and Coverage

Some members have noticed changes in out-of-pocket costs for certain medications. The most common reason for this change is due to drugs moving to different tiers between OptumRx and CVS.

What you can do:

  • Review the formulary and exclusions list under your health plan to check the coverage and tier of your medications.
  • If your medication moved to a higher tier or is no longer covered, you should have received a letter with details, alternatives, and next steps.
  • If your doctor believes your medication is medically necessary and an alternative is not appropriate, they can request an exception for medical necessity.

3. Avoid Missed Medications: Planning Ahead

To avoid interruptions, it’s a good idea to plan your refills in advance. Most retail pharmacies remain in the CVS network, and mail order delivery continues to be available.

What you can do:

  • For retail pharmacies, you can request refills within one week of your medication running out. For mail order, you can request a refill two weeks in advance.
  • If you use mail order, most prescriptions transferred automatically to CVS. If a new prescription is needed or if you’d like to learn more about mail order service, you can call CVS or SilverScript.
  • Always use your new ID card when filling prescriptions, even if you’re at the same pharmacy you used before.

4. Understanding Your Choices if Issues Arise

We understand that you need reliable access to your medication. If you experience a delay, shortage, or coverage issue, there are steps you can take to resolve the problem quickly.

What you can do:

  • If your medication is delayed or out of stock, ask your pharmacist about alternatives or nearby pharmacies with availability. For further assistance, Basic members can call CVS at (833) 291-3649. Medicare members should call SilverScript at (833) 291-3648.
  • If you have a CVS account, you can use the Find a Local Pharmacy tool to find in-network pharmacies, including major chains and local options. If you don’t have an account, you can select your health plan and search pharmacies through the main CVS website.
  • If you receive a letter about a formulary change, review the covered alternatives and talk with your doctor about the best option for your health needs.

5. Still Have Questions? Reach Out for Support

CVS Caremark and SilverScript customer service teams are available 24/7 to answer your questions and resolve issues. If you’ve already contacted them, we’re available to help.

What you can do:

  • Start by calling CVS Caremark at (833) 291-3649 for Basic plans or SilverScript at (833) 291-3648 for Medicare plans.
  • Access digital tools and resources including pharmacy and formulary search features.
  • If you’ve tried these steps and still need assistance, contact the CalPERS call center at 888 CalPERS (or 888-225-7377) for additional support.

We’re Committed to Your Health

Transitions can be challenging, and our goal is to ensure you continue to receive the care and medications you rely on. We’re proud to serve those who serve California, and we’re here to help every step of the way.