Welcome to Scrip World Client Welcome Packet for Important Contact Information Important plan contacts What do you need help with? Who to contact Performance Drug List Scrip World, powered by 1.866.475.7589 Participating pharmacies CVS/caremark Customer Service www.meritain.com Mail service Scrip World, powered by My prescription drug benefits 1.866.475.7589 CVS/caremark Customer Service Please note: if you’re having difficulty filling a prescription, or any other sort of issue, simply call the number listed on your ID Card. Meritain Health | 8 CVS Health National Network Participating Retail Pharmacies The following list shows the major chain pharmacies that accept your members’ prescription ID card. In addition to these, many independent pharmacies also take part in the prescription program. If your members need to find out if a pharmacy not listed here accepts their card, they should call the pharmacy directly. A E I A & P Pharmacy Eaton Apothecary IHC Health Center Accredo Health Group, Inc. Ingles Pharmacy ACME Pharmacy F Albertson’s Pharmacy Fairview Pharmacy J Ameridrug Pharmacy Farm Fresh Pharmacy Jewel-Osco Pharmacy Aurora Pharmacy Food City Pharmacy Food Lion Pharmacy K B Fred Meyer’s Pharmacy Kerr Drug Baker’s Pharmacy Fred’s Pharmacy Kessel Pharmacy Bartell Drugs Fresh Market King Sooper’s Pharmacy Bel Air Pharmacy Pharmacy Kinney Drugs Bi-Lo Pharmacy Fruth Pharmacy Klein’s Pharmacy Bi-Mart Pharmacy Fry’s Food and Drug Klingensmith’s Drug Brookshire Pharmacy Kmart Pharmacy G Knight Drug C Gerbes Pharmacy Kroger Pharmacy Carrs-Gottstein Foods Pharmacy Giant Eagle Pharmacy Kroger Sav-on Pharmacy Cashwise Pharmacy Giant Pharmacy City Market Pharmacy Group Health Pharmacy L Coborn’s Pharmacy Lincare Infusion Services Copps Pharmacy H Long’s Drugs Coram Healthcare Pharmacy Haggen Pharmacy Costco Pharmacy Hannaford Food & Drug M Critical Care Systems Harmons Pharmacy Marianos Pharmacy Cub Pharmacy Harps Pharmacy Marsh Drug Store CVS Pharmacy Harris Teeter Pharmacy Martin’s Pharmacy CVS Pharmacy in Target stores Harveys Supermarket Pharmacy Maxor Pharmacy CVS Specialty HealthPartners Pharmacy May’s Drug Store H-E-B Pharmacy Med-Fast Pharmacy D Hen House Pharmacy Medicap Pharmacy Dierbergs Pharmacy Henry Ford Medical Center Medicine Shoppe Pharmacy Dillon Pharmacy Pharmacy Meijer Pharmacy Discount Drug Mart Homeland Pharmacy Metro Market Pharmacy Doc’s Drugs Horton & Converse Pharmacy Drug Warehouse Humana Pharmacy Duane Reade Hy-Vee Pharmacy CVS Caremark® reserves the right to review and update the National Network Participating Retail Pharmacies List. www.caremark.com ©2016 CVS Caremark. All rights reserved. 106-29293A 110716 National Network Participating Retail Pharmacies (cont.) N S W Navarro Discount Pharmacy Safeway Pharmacy Wal-Mart Pharmacy NCS Healthcare Pharmacy Sam’s Club Pharmacy Walgreens Pharmacy Neighborcare Pharmacy Sav-Mor Pharmacy Wegman’s Pharmacy Nob Hill Pharmacy Save Mart Pharmacy Weis Pharmacy North Florida Pharmacy Sav-On Pharmacy White Drug Schnucks Pharmacy Winn-Dixie Pharmacy O Scolari’s Pharmacy Omnicare Pharmacy Scott’s Pharmacy Oncology Pharmacy Shaw’s Pharmacy Option Care Pharmacy Shop ‘n Save Pharmacy Osco Pharmacy Shopko Pharmacy Shoppers Pharmacy P ShopRite Pharmacy Pavilions Pharmacy Smith’s Pharmacy Pick N Save Pharmacy St John Pharmacy PrescribeIT Rx Pharmacy Stop & Shop Pharmacy Price Chopper Pharmacy Super 1 Pharmacy Price Cutter Pharmacy Super D Drugs Publix Pharmacy Super One Pharmacy Super RX Pharmacy Q QFC Pharmacy T Quick Chek Pharmacy Texas Oncology Pharmacy Thrifty White Pharmacy R Times Pharmacy Raley’s Drug Center Tom Thumb Pharmacy Ralphs Pharmacy Tops Pharmacy Randall’s Pharmacy Recept Pharmacy U Rite Aid Pharmacy United Market Street Pharmacy Ritzman Pharmacy United Pharmacy USA Drug UW Health Pharmacy Services V Vons Pharmacy CVS Caremark reserves the right to review and update the National Network Participating Retail Pharmacies List. www.caremark.com ©2016 CVS Caremark. All rights reserved. 106-29293A 110716 Formulary Drug List January 2017 Performance Drug List The CVS Caremark® Performance Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. PLAN MEMBER HEALTH CARE PROVIDER Your benefit plan provides you with a prescription benefit program Your patient is covered under a prescription benefit plan administered by CVS Caremark. Ask your doctor to consider administered by CVS Caremark. As a way to help manage health prescribing, when medically appropriate, a preferred medicine from care costs, authorize generic substitution whenever possible. If you this list. Take this list along when you or a covered family member believe a brand-name product is necessary, consider prescribing a sees a doctor. brand name on this list. Please note: Please note: • Your specific prescription benefit plan design may not cover • Generics should be considered the first line of prescribing. certain products or categories, regardless of their appearance in The member's prescription benefit plan design may alter this document. Products recently approved by the U.S. Food • 1 and Drug Administration (FDA) may not be covered upon coverage of certain products or vary copay amounts based on release to the market. the condition being treated. This drug list represents a summary of prescription coverage. • Your prescription benefit plan design may alter coverage of • certain products or vary copay 1 amounts based on the condition It is not all-inclusive and does not guarantee coverage. The being treated. member’s specific prescription benefit plan design may not cover certain products or categories, regardless of their • You may be responsible for the full cost of non-formulary appearance in this document. Products recently approved by products that are removed from coverage. the FDA may not be covered upon release to the market. For specific information regarding your prescription benefit • 1 • The member's prescription benefit plan may have a different coverage and copay information, please visit copay 1 for specific products on the list. www.caremark.com or contact a CVS Caremark Customer Care representative. • Unless specifically indicated, drug list products will include all dosage forms. • CVS Caremark may contact your doctor after receiving your 1 prescription to request consideration of a drug list product or • Log in to www.caremark.com to check coverage and copay generic equivalent. This may result in your doctor prescribing, information for a specific medicine. when medically appropriate, a different brand-name product or generic equivalent in place of your original prescription. • In most instances, a brand-name drug for which a generic product becomes available will be designated as a non- preferred option upon release of the generic product to the market. ANALGESICS COLCRYS HYSINGLA ER § ERYTHROMYCINS / § TETRACYCLINES ULORIC NUCYNTA MACROLIDES doxycycline hyclate § NSAIDs NUCYNTA ER azithromycin minocycline § OPIOID ANALGESICS diclofenac sodium OPANA ER clarithromycin tetracycline codeine-acetaminophen meloxicam OXYCONTIN clarithromycin ext-rel fentanyl transdermal § ANTIFUNGALS naproxen SUBSYS erythromycins fentanyl transmucosal DIFICID fluconazole § NSAIDs, COMBINATIONS VISCOSUPPLEMENTS lozenge itraconazole diclofenac sodium- hydrocodone-acetaminophen GEL-ONE § FLUOROQUINOLONES terbinafine tablet misoprostol hydromorphone HYALGAN ciprofloxacin ANTIRETROVIRAL AGENTS hydromorphone ext-rel SUPARTZ FX ciprofloxacin ext-rel § NSAIDs, TOPICAL methadone levofloxacin § ANTIRETROVIRAL diclofenac sodium solution ANTI-INFECTIVES morphine moxifloxacin COMBINATIONS VOLTAREN GEL morphine ext-rel ANTIBACTERIALS ATRIPLA morphine suppository § PENICILLINS § COX-2 INHIBITORS § CEPHALOSPORINS COMPLERA oxycodone amoxicillin EPZICOM celecoxib oxycodone-acetaminophen cefdinir amoxicillin-clavulanate EVOTAZ cefprozil § GOUT tramadol dicloxacillin PREZCOBIX tramadol ext-rel cefuroxime axetil penicillin VK allopurinol STRIBILD BUTRANS cephalexin colchicine tablet TRIUMEQ FENTORA SUPRAX probenecid TRUVADA Your specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. For specific information, visit www.caremark.com or contact a CVS Caremark Customer Care representative. INTEGRASE INHIBITORS § ACE INHIBITOR / PCSK9 INHIBITORS PROSTAGLANDIN venlafaxine ISENTRESS DIURETIC COMBINATIONS REPATHA VASODILATORS venlafaxine ext-rel capsule TIVICAY fosinopril-hydrochlorothiazide ORENITRAM PRISTIQ § BETA-BLOCKERS lisinopril-hydrochlorothiazide § NUCLEOSIDE REVERSE SOLUBLE GUANYLATE § MISCELLANEOUS quinapril-hydrochlorothiazide atenolol AGENTS TRANSCRIPTASE carvedilol CYCLASE STIMULATORS INHIBITORS § ANGIOTENSIN II metoprolol succinate ext-rel ADEMPAS bupropion abacavir RECEPTOR ANTAGONISTS / metoprolol tartrate bupropion ext-rel § MISCELLANEOUS lamivudine DIURETIC COMBINATIONS nadolol mirtazapine candesartan / candesartan- propranolol RANEXA