Partnership Program Pharmacy

Prescriptions will be filled automatically with a generic drug if one is available.

• If your doctor believes a non-preferred brand-name drug is medically necessary for you, they must complete the Coverage EXCEPTION REQUEST FORM and fax it to CVS Caremark. If approved, you will pay the preferred brand copay amount.
• If you request a brand-name drug instead of a generic alternative without obtaining a Coverage Exception Request Form, you will pay the generic drug copay PLUS the difference in cost between the brand and generic drug.

Certain chronic or genetic conditions require special pharmacy products, often injected or infused. Pharmacies include Hartford Healthcare, University of Connecticut Health Center, Yale New Haven Health, and CVS Specialty Drug Pharmacy, offering expert support and resources to meet your unique medication needs. To learn more or explore these options, call (800) 237-2767.

The current preferred drug list is chosen because of their clinical effectiveness and safety. The list can be viewed on the Quarterly Performance Drug List

The CVS Caremark Pharmacy and Therapeutics Committee adjusts this list quarterly as new generics become available, new clinical studies have been released, new brand-name drugs become available, etc. This list is typically updated every three months and promotes the use of preferred brand-name and generic drugs whenever possible.

The U.S. Food and Drug Administration (FDA) requires generic drugs to be therapeutically equivalent to a brand-name drug in dosage, strength, route of administration, quality, performance, and intended use. Generally, generic drugs cost less than brand-name drugs.

When you fill a prescription for a specialty drug, you will automatically be enrolled in a PrudentRx program that reduces your out of pocket cost to $0. You can choose to opt out of this program during Open Enrollment. Opt out form

A maintenance drug is a prescription commonly used to treat chronic or long-term conditions, like high blood pressure, heart disease, asthma, and diabetes. The copay and prescription refill rate depend on your chosen pharmacy and the drug class. This approach helps the state ensure access, reduce waste, and effectively manage costs.

For generic medications, you will receive a 30-day supply for the first month, followed by a 90-day supply for subsequent refills.

For brand medications, there are two options for supply cadence:

• 90-day fills at a State Maintenance Drug Network pharmacy
• 30-day fills at a CVS Maintenance Choice Optimized Network pharmacy

To view the full list of pharmacies, including your prescription fill options, use the Maintenance Drug Network search tool. You can also choose to receive all your medication through the CVS Caremark mail-order pharmacy in 30-day increments. For more information, call CVS at 1-800-318-2572.

To request an exemption for the patient to continue receiving a 30-day supply, have your provider complete the MANDATORY MAIL EXCEPTION FORM.

If your Weight Management Medication was denied at the pharmacy click here for more information.

A denied prescription may occur due to the following circumstances:

• Refilling a medication too soon
• Specialty drugs require a specialty drug pharmacy
• Drug quantity limits exist
• Compound medication; not commercially available

If your prescription requires a revision, CVS Caremark will mail instructions to you and to the prescriber. Your prescriber may need to complete a Prior Authorization Form for formulary-covered drugs, or if the drug is not on the current preferred drug list, you will need to submit a Coverage Exception Request Form.