PRESCRIPTION DRUG COVERAGE
Our pharmacy network
Enjoy a nationwide network of over 65,000 pharmacies.
CVS Caremark is your network pharmacy. A network pharmacy is a pharmacy that we have made arrangements with to provide prescription drugs to our members. Once you go to a network pharmacy, you are not required to continue going to the same network pharmacy to fill your prescriptions. You can go to any of our network pharmacies or skip the trip and use our convenient mail order pharmacy program.
Caremark.com provides secure access, helpful tools and personal prescription information that allows you to manage your pharmacy benefits, 24/7.
Register now for your password-protected account and take advantage of these and other benefits:
- Review prescription history
- Check drug pricing and coverage
- View and print prescription history and spending
- Review prescription savings opportunities
- Access your monthly Explanation of Benefits (EOB) statements online
- Start, refill and track prescriptions through Rx Delivery by Mail
- Check status of Rx Delivery by Mail prescriptions
Questions?
We’re a phone call away.
PPO Members:
HMO Members:
There are three easy ways to register with CVS Caremark.
WHAT’S COVERED
Advantage MD covers both Medicare Part B and Part D* medications.
We know prescription drug coverage is very important to you. That’s why Advantage MD offers a Part D prescription benefit with our plan options.
Our plan covers most Part D vaccines at no cost to you. and you won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.
Our comprehensive formulary is a complete list of Medicare-approved, prescription brand-name and generic medications we cover.
Out-of-Network Pharmacies
Unable to use a network pharmacy? We’ve got you covered.
When you are unable to use a network pharmacy, Advantage MD will cover drugs filled at an out-of-network pharmacy. If you are experiencing any of these situations, you can call us 24 hours a day, seven days a week, so we can see if there is a network pharmacy nearby.
The prescription is for a medical emergency or urgent care.
You are unable to get a covered drug in a time of need because there are no 24-hour network pharmacies within a reasonable driving distance.
The prescription is for a drug that is out-of-stock at an accessible network retail or mail service pharmacy (including high-cost and unique drugs).
If you are evacuated or otherwise displaced from your home because of a Federal Disaster or other public health emergency declaration.
A vaccine or drug administered in your doctor’s office.
Get Reimbursed for Out-of-Network Prescriptions
If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost.
Send us your request for payment, along with your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records.
To make sure you are giving us all the information we need to make a decision, you can fill out our claim form to make your request for payment. You don’t have to use the form, but it will help us process the information faster.
If you don’t know what you should have paid, or if you received bills and you don’t know what to do about those bills, we can help. If you have any questions, you can contact us 24 hours a day, seven days a week.
Where to Mail Your Request
Mail your request for payment together with any bills or receipts to us at this address:
Johns Hopkins Advantage MD
c/o CVS/Caremark Part D Services
PO BOX 52066
Phoenix, AZ 85072-2066
Frequently Asked Questions About Pharmacies
When can I use a pharmacy that is not in the plan’s network?
Generally, Johns Hopkins Advantage MD covers drugs filled at out-of-network pharmacies only when you are not able to use a network pharmacy.
Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:
- The prescription is for a medical emergency or urgent care.
- You are unable to get a covered drug in a time of need because there are no 24-hour network pharmacies within a reasonable driving distance.
- The prescription is for a drug that is out-of-stock at an accessible network retail or mail service pharmacy (including high-cost and unique drugs).
- If you are evacuated or otherwise displaced from your home because of a Federal disaster or other public health emergency declaration.
- A vaccine or drug administered in your doctor’s office.
If you are experiencing any of these situations, you can call us 24 hours a day, seven days a week so we can see if there is a network pharmacy nearby.
PPO members: call 877-293-5325 (TTY: 711).
HMO members: call 877-293-4998 (TTY: 711).
Note: It may cost you more to obtain your medications at an out-of-network pharmacy. If you do need to go to an out-of-network pharmacy for any of the reasons listed above, the plan will cover up to a one-month supply of drugs.
How do I get reimbursed from the plan if I pay at an out-of-network pharmacy?
If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost.
Send us your request for payment, along with your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records.
To make sure you are giving us all the information we need to make a decision, you can fill out our claim form to make your request for payment.
You don’t have to use the form, but it will help us process the information faster.
Mail your request for payment together with any bills or receipts to us at this address:
Johns Hopkins Advantage MD
c/o CVS/Caremark Part D Services
PO BOX 52066
Phoenix, AZ 85072-2066
If you don’t know what you should have paid, or if you received bills and you don’t know what to do about those bills, we can help. If you have any questions, you can contact us 24 hours a day, seven days a week.
PPO members: call 877-293-5325 (TTY: 711).
HMO members: call 877-293-4998 (TTY: 711).
*Part D is not available for Advantage MD Tribute members.
