Pharmacy Info
Local and National Pharmacy Access
With CDPHP Medicare Choices Drug Plans, you'll have access to 4,740 pharmacies throughout New York state and more than 62,000 pharmacies across the country.
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You can also choose to have your prescription filled and mailed directly to your home or office using the Caremark® mail order pharmacy service.
Preferred Pharmacy
Prescriptions that are included in the Part D formulary must be filled at a network or "preferred" pharmacy to receive coverage. However, there may be extenuating circumstances for which you can obtain coverage for a formulary drug that is filled out-of-network.
Preferred pharmacies are pharmacies in our network for which our Plan negotiated lower cost sharing for plan members for covered prescription drugs than “non-preferred pharmacies.” However, you will still have access to lower drug prices at “non-preferred pharmacies” than at out-of-network pharmacies. You may go to either of these types of network pharmacies to receive your covered prescription drugs. Preferred pharmacies include all CVS locations nationwide and the Caremark® Mail Order Service.
Even though CVS/pharmacy is the preferred vendor for CDPHP Medicare Choices, be sure to show your CDPHP prescription drug ID card when you use a prescription discount program at places like Price Chopper, Hannaford, and Walmart. CDPHP members are still eligible to receive those discounts.
Out-Of-Network Pharmacy
Out-of-network pharmacies are those pharmacies that are not in the plan's network. If you do go to an out-of-network pharmacy, you may have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. You may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged.
When to Use an Out-Of-Network Pharmacy
- When you are traveling outside your plan’s service area.
- If you lose or run out of your covered drugs or you become ill and need a covered drug immediately and cannot access a network pharmacy.
- If you cannot obtain a covered drug within your service area in a timely manner due to lack of availability of a participating network pharmacy.
- If your covered drug is provided by an out-of-network institution-based pharmacy while you are in an emergency department, provider-based clinic, outpatient surgery, or other outpatient setting.
- If you are administered a vaccine covered by your plan in a physician’s office.
- If you must fill a covered drug prescription and the drug is not regularly stocked at accessible network retail or mail-order pharmacies.
How to submit a paper claim for an out-of-network prescription
If you go to an out-of-network pharmacy for any of the reasons listed above, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription and mail the completed claim form along with the receipt to:
CVS Caremark Part D Service, LLC
Medicare Part D Paper Claims
P.O. Box 52092
Phoenix, AZ 85072-2092
Upon receipt, an initial coverage determination will be made on the claim. For more information on initial coverage determinations, limits, and financial responsibilities, please refer to your Evidence of Coverage or call Customer Care.