How to File a Prescription Drug Claim
If a participant uses a pharmacy that participates in the prescription drug program, there is no claim to file. The participant will pay the applicable deductible and copayment at the time of purchase. The prescription drug deductible and copayment are the participant's responsibility and will not be reimbursed under the prescription drug program or the medical program. See Time Limit for Claims Filing.
If a participant uses a pharmacy that does not participate in the prescription drug program, a paper claim must be filed. A participant can get a prescription drug claim form online at www.caremark.com or by contacting CVS Caremark Customer Care. The claim form must be completed in its entirety to avoid delays in processing. Pharmacy receipts must be attached to the claim form. The completed form can be mailed to CVS Caremark or completed online at www.caremark.com.
The participant will be reimbursed the difference between the Plan's allowable charge and the copayment amount, once the applicable deductible has been met. Any charge for a prescription drug that exceeds the Plan's allowable charge will be the participant's responsibility and will not be applied toward meeting the deductible or copayment.
If another plan is primary, the claim must be filed with that plan first. When an EOB from the other plan has been received, the claim must be filed with CVS Caremark. The claim must be filed with a copy of the other plan's EOB and the pharmacy receipts. If the other plan's EOB is not received, the claim will be denied until the information is received.