What’s the background?
In July, the CalPERS Board of Administration approved a five-year contract with pharmacy benefit manager (PBM) CVS Caremark (CVS) to provide prescription benefits to members in specific health plans. These benefits include services such as processing pharmacy claims, managing the list of covered medications, and providing you additional tools and support.
Check out these frequently asked questions to learn more about the transition or visit CVS Caremark Pharmacy Benefits for additional information.
Which health plans are affected by the PBM change?
The following CalPERS health plans will be covered under this new partnership. If your plan is not listed, then it remains unaffected by this change.
Basic
- Anthem Blue Cross Traditional
- Anthem Blue Cross Select
- Health Net of California Salud y Más
- PERS Gold Basic
- PERS Platinum Basic
- Sharp Health Plan Performance Plus
- UnitedHealthcare SignatureValue Alliance
- UnitedHealthcare SignatureValue Harmony
- Western Health Advantage
Medicare
- Anthem Blue Cross Medicare Preferred
- PERS Gold Medicare Supplement
- PERS Platinum Medicare Supplement
Which health plans are not affected by the PBM change?
The following CalPERS health plans are not impacted by this change.
Basic
- Blue Shield Access+ (HMO & EPO)
- Blue Shield Trio
- Kaiser Permanente
Medicare
- Blue Shield Medicare Advantage
- Kaiser Permanente Senior Advantage
- Kaiser Permanente Senior Advantage Summit
- Sharp Direct Advantage
- UnitedHealthcare Medicare Advantage
When will the new PBM take effect?
The new PBM will take effect on January 1, 2026.
Why is CalPERS switching to CVS Caremark for pharmacy benefits?
This change is being made to enhance our pharmacy services and better manage your prescription benefits. CalPERS chose CVS because of its strong commitment to performance guarantees in key areas such as managing pharmacy costs, ensuring clinical quality, and increasing transparency. This change is designed to provide you with high-quality service while ensuring your access to safe and effective medication.
What is SilverScript and is it different from CVS Caremark?
SilverScript is part of CVS Caremark and will administer pharmacy benefits for Medicare members in the Anthem Blue Cross Medicare Preferred PPO, as well as PERS Gold and PERS Platinum Medicare Supplement plans. The main difference between SilverScript and CVS is the branding you’ll see on materials you receive.
Medicare members will receive a welcome kit from SilverScript that includes your pharmacy benefits ID card and information about accessing Caremark.com/CalPERS and the CVS Health app prior to January 1, 2026.
If SilverScript is administering my Medicare pharmacy benefits, does the rest of this information still apply?
Yes, the information in this article applies to both Basic and Medicare members.
What does this change mean for me?
Pharmacy access remains similar, as most members can continue using their current pharmacy. There will be some formulary changes and there may be changes to copays. However, the number of members affected by this is low. You will still have access to the safe and effective medication you need. There will be plans in place to ensure a smooth transition for filling prescriptions impacted by a formulary change, and for an automatic transfer of approved prior authorizations.
What are formulary changes?
A formulary change refers to modifications made to the list of covered prescription drugs. These changes can involve adding, removing, or reclassifying drugs, as well as adjusting prior authorization or step therapy requirements.
How will I know if my medications are changing?
If your medication is impacted, CVS will notify you by mail and provide additional information, including safe and effective alternatives to discuss with your doctor.
If your medication is affected by a formulary change — for example, no longer covered or moved to a higher tier — you will receive a personalized letter approximately 30 to 60 days before the effective date of January 1, 2026. This letter will include:
- Covered alternatives
- Next steps if you need to request a formulary exception
- How to speak with your doctor about switching medications
You can review the formulary and exclusions lists for Basic plans and Medicare to verify the status of your medication now:
- Basic Plan Formulary (PDF)
- Basic Plan Exclusions (PDF) – List of medications currently covered but will be excluded from the Basic formulary starting January 1, 2026. For all excluded drugs, safe and effective alternatives are available.
- Medicare Formulary (PDF)
- Medicare Exclusions (PDF) – List of medications currently covered but will be excluded from the Basic formulary starting January 1, 2026. For all excluded drugs, safe and effective alternatives are available.
Will my pharmacy still be in network?
CVS Caremark’s retail pharmacy network is national in scope and is comprised of more than 64,000 pharmacies, including major chains, regional pharmacies, and independents. While rare, there could be some changes to your retail pharmacy (for example, due to pharmacy closures). In the coming months, members will receive a letter notifying them if they will experience any pharmacy network changes. You can also confirm whether a specific pharmacy will be in network using CVS’s pharmacy locator found at Caremark.com/CalPERS.
Will my prescriptions automatically transfer from OptumRx to CVS?
Non-controlled prescriptions with refills remaining that are currently filled at OptumRx mail and specialty pharmacies will automatically transfer to CVS. Some prescriptions may require a new prescription from your doctor, such as controlled substances or expired refills. CVS will notify you prior to the effective date if action is needed. Medicare members utilizing a specialty pharmacy will be receiving a letter with information about options.
Will I still be able to get my medications delivered by mail?
Yes. The mail order pharmacy will change, but mail order delivery will continue to be an option. Most mail order prescriptions will transfer automatically, and you will receive instructions on how to place your first fill.
Many prescriptions will be transferred automatically to CVS. Some medications may require a new prescription from your doctor, such as controlled substances or expired refills. CVS will notify you prior to the effective date if action is needed.
What if my prescription doesn’t transfer in the transition?
For prescriptions that can’t be transferred, such as controlled substances or prescriptions with no remaining refills, please contact your prescriber or CVS.
- Basic plan members can call CVS Customer Care: 833-291-3649.
- Medicare plan members can call SilverScript Customer Care: 833-291-3648.
Am I able to get an exception if my medication is no longer covered and my physician believes it is the most effective for my condition?
Your physician can request a medical necessity exception for your medication if it is no longer covered but they believe it is the most effective medication for your condition. Additionally, for Basic (non-Medicare) plans, if you need more time to make a change from your excluded drug to a preferred medication, you can call CVS’s dedicated team and request a 90-day transition fill. For Medicare plan members impacted by the formulary change, there will be a 90-day transition period for filling prescriptions prior to switching to an equally safe and effective alternative medication.
Is there a specific number I call if I have questions regarding the transition?
CVS is prepared to welcome CalPERS members who would like to call in and speak with a live representative. Representatives can provide members with more information about their new prescription benefits. CVS phone lines are open 24 hours, 7 days a week.
- Basic plan members can call CVS Customer Care: 833-291-3649.
- Medicare plan members can call SilverScript Customer Care: 833-291-3648.
When will I receive my new insurance card from my health plan reflecting CVS Caremark as the new pharmacy benefits manager?
You will receive a new ID card a few weeks before January 1, 2026. Please be sure to monitor your mailbox and use this card for all prescription services starting on January 1, 2026. Basic plan members will receive a new member ID card from their health plan with updated pharmacy information, and SilverScript will send a new member ID card for Medicare members.