Pharmacy Benefits
All Partners for Health medical plans include pharmacy benefits, managed by CVS Caremark. Visit tn.gov/partnersforhealth/health-options/health to learn what health insurance plans are available.
Contact CVS Caremark
Phone: 877.522.TNRX (8679) | 24/7
Website: info.caremark.com/stateoftn
Need an ID card?
Members can request ID cards by calling CVS Caremark or using the CVS Caremark mobile app.
Review the CVS Caremark performance drug list. It’s updated each January, April, July and October.
Click here for a list of medications with utilization management requirements such as prior authorization, step therapy or quantity limits.
Contact your doctor and ask him/her to call CVS Caremark directly at (800) 294.5979 (doctors only) to request prior authorization for your prescription.
How our pharmacy benefits work
The health plan you choose determines your out-of-pocket prescription costs, including copay, coinsurance, deductible and out-of-pocket maximum.
State and Higher Education Employees and Retirees: Review the 2024 health options comparison chart to see pharmacy copays, coinsurance, deductible and out-of-pocket maximum.
Local Education and Local Government Employees and Retirees: Review the 2024 health comparison chart to see pharmacy copays, coinsurance, deductible and out-of-pocket maximum.
1. *The drug tier
Your choice of a generic, preferred brand, non-preferred brand or specialty drug (two different cost tiers in the preferred provider organization plans) will help determine price.
2. The day supply you receive
A 30-day (or <30) supply or 90-day (>31) supply
3. **Where you fill your prescription
If you choose retail, Retail-90 or a mail order pharmacy
*Prescription Drug Tiers
Tier One/generic drugs: You’ll pay the lowest amount. A generic medicine is approved by the Food and Drug Administration and equal to the brand name product in safety, effectiveness, quality and performance.
Tier Two/preferred brand drugs: You’ll pay a higher amount. Many popular and highly used brands are included on the performance drug list.
Tier Three/non-preferred brand drugs: You’ll pay the highest amount. These belong to the most expensive group of drugs. These drugs are not included on the performance drug list.
Specialty drug tiers: In the Standard, Premier and Limited PPOs, there are two drug tiers. For generics in a 30-day supply, 20% coinsurance applies with a $100 member minimum and a $200 maximum out-of-pocket. In the PPOs for all other brands, a 30-day supply, 30% coinsurance applies with a $200 member minimum and a $400 maximum out-of-pocket.
Members enrolled in a consumer-driven health plan pay coinsurance for specialty drugs and are responsible for the full insurance-negotiated cost of the drug until you reach your plan’s deductible.
All medications that are classified as a specialty medication may only be filled in a 30-day supply and must be filled either through the CVS Specialty Pharmacy OR through one of the retail pharmacies in the state’s custom specialty pharmacy network found here: caremark.com/portal/asset/tn_specialty_networklist.
** Find a CVS Caremark Network Pharmacy
You can find a 30-day or 90-day network pharmacy through the CVS Caremark website at info.caremark.com/stateoftn. You can also call CVS Caremark customer service at 877.522.8679 to find a network pharmacy near you.
Additional Pharmacy Benefits and Savings
Tobacco quit products
Members who want to stop using tobacco can get free tobacco quit aids.
Vaccinations
Learn more about Flu, Pneumococcal, RSV and Covid Vaccine Coverage.
Diabetic supplies
The only covered meters, test strips and supplies are those from OneTouch and Accu-Chek. The only covered needles and syringes are BD brand products. Members will have lower copays using supplies from these preferred brands.
Enrolled members with diabetes may be eligible for a new OneTouch or Accu-Chek blood glucose meter at no charge from the manufacturer. For more information on how to obtain a free blood glucose meter, call 877.418.4746.
Certain low-dose statins
Eligible members can receive these medications in-network at zero cost share. These medications are primarily used to treat high cholesterol. No high-dose or brand name statins are included. Applies to members ages 40 through 75 years old.
Certain medications used to treat opioid dependency
Members won’t have to pay for some of these medications.
Need Help?
• Call 877.522.8679 or go to info.caremark.com/stateoftn.
• Register on the CVS Caremark website and get details about your drug costs, download the mobile app and more.
• Find answers to Frequently Asked Questions.
Tips to Save on Your Prescriptions
Medications you fill on an ongoing basis could cost you less by filling them at a participating Retail-90 pharmacy or through CVS Caremark Mail Service. You make fewer trips to the pharmacy and only need to make one payment every three months. There are several ways to get a 90-day supply of the drugs you take regularly for ongoing conditions. Find a list of Retail-90 pharmacies by going to info.caremark.com/stateoftn.
Maintenance drugs
Under the maintenance medication benefit, you can get a 90-day supply of certain drugs from a Retail-90 or mail-order pharmacy at a reduced cost. If you fill a 30-day supply, your regular copayment or coinsurance applies and for Consumer-driven Health Plan members, the deductible is not bypassed.
The maintenance medication benefit applies to drugs in the following classes: coronary artery disease, congestive heart failure, hypertension, diabetes, asthma/COPD, depression, statins used for high cholesterol and osteoporosis.
You will pay a reduced copay or coinsurance for certain medications in these classes if you fill them in a 90-day supply through either mail order OR at one of the participating Retail-90 pharmacies found here: https://www.caremark.com/portal/asset/Mail_Retail_Network_Listing.pdf.
Pharmacy Benefits
Members have the right to appeal a denial made by CVS Caremark. There are three levels of appeal available:
- First Level Appeal — If the member's prescription requires prior authorization, and the request is denied because it does not meet their plan's approved criteria for use of the medication, the member may choose to appeal the denial. The member or their authorized representative may request that CVS Caremark re-review the request along with any additional clinical information that the member's physician provides. If this appeal request is not approved, the member will receive a letter explaining the decision and providing information about how to request a second level internal appeal from CVS Caremark.
- Second Level Appeal — If the member's first level appeal is denied, the member or their authorized representative may choose to request that CVS Caremark review the case and determine whether the drug is medically necessary for the member's treatment. CVS Caremark will review the case and any additional clinical information provided by the member's physician to make this determination. If this appeal is not approved, the member will receive a letter explaining the decision and providing information about how to request an external review of their case from an independent review organization.
- External Review — If the member's second level internal appeal is denied, the member or their authorized representative may choose to request that an independent review organization review the case and make a final determination. The independent review organization will communicate their decision to the member. This decision will be final and binding on the member, the plan and CVS Caremark.