2024 Pharmacy Information
Find a Pharmacy Near You
Through CVS/caremark, we currently have over 65,000 pharmacies in our nationwide network. Use the pharmacy locator tool to search for a network pharmacy in your area. 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.
Mail Order Pharmacy Program
For certain kinds of drugs, you have the option to sign up for your plan’s network mail order services and get prescription drugs shipped to your home. Generally, the drugs provided through the mail order service are drugs that you take on a regular basis for a chronic or long-term medical condition.
Our plan’s mail order service allows you to conveniently order up to a 100-day supply of medication on Tier 1 and up to a 90-day supply of medication on Tier 2 through Tier 4 at two times the 30-day copay, saving you money and time. Drugs in Tier 5 are only available as a 30-day supply. However, Advantage MD D-SNP may fill up to a 90-day supply for all drugs. Usually a mail-ordered prescription will get to you in no more than ten days. If the mail-order pharmacy expects the order to be delayed, they will notify you of the delay. If you need to request a rush order because of a mail-order delay, you may contact Customer Care to discuss options which may include filling at a local retail pharmacy or expediting the shipping method. Provide the representative with your ID number and prescription number(s).
If your order does not arrive within ten days, you may also call us 24 hours a day, seven days a week.
PPO members: 877-293-5325 (TTY: 711).
HMO members: 877-293-4998 (TTY: 711).
4 easy ways to sign up:
- Online. Sign in or register your account on caremark.com. Click “Order Prescriptions,” then click “Request a New Prescription” to enter your medication.
- Call us. PPO members, call 877-293-5325 (TTY: 711); HMO members, call 877-293-4998 (TTY: 711). We are available 24 hours a day, seven days a week. You will be asked to provide your doctor’s information, medication, and prescription payment method.
- Ask your doctor. Ask your doctor to submit your prescriptions electronically, by fax, or over the phone.
- Download and mail. You can download, print, fill out, and submit the mail service order form to CVS/caremark to enroll.
Refills
As part of the mail order pharmacy program, you have the option to sign up for an automatic refill program. Under this program we will start to process your next refill automatically when our records show you should be close to running out of your drug. The pharmacy will contact you prior to shipping each refill to make sure you are in need of more medication, and you can cancel scheduled refills if you have enough of your medication or if your medication has changed.
If you choose not to use our auto-refill program but still want the mail-order pharmacy to send you your prescription, please contact your pharmacy 15 days before your current prescription will run out. This will ensure your order is shipped to you in time. To opt out of our program that automatically prepares mail order refills, please contact us by logging in to your Caremark.com account or by calling Customer Care.
For more information, please refer to your Evidence of Coverage (EOC).
Out-of-Network Pharmacy Coverage
When can I use a pharmacy that is not in the plan's network?Collapse
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?Collapse
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).
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