Our pharmacy network

It can be found on the front of your health plan ID card.

The benefit lets you get over-the-counter items by going to any allowed stores. You can also order by phone at 1-888-628-2770 (TTY: 711) Monday to Friday, from 9 AM to 8 PM local time or online. You order from a list of approved items, and it will be sent to your address.

The amount depends on your benefit plan. Check your plan documents or call OTC Health Solutions at 888-628-2770 (TTY: 711).

Unused benefit amounts do not roll over to the next quarter.

You cannot exceed your benefit amount online or by phone. However, you may exceed your benefit amount at any allowed CVS Pharmacy® store and pay the difference out of pocket.

Not all items are available in stores. Items marked with a truck icon in the catalog can only be ordered over the phone or online.

Orders can only be canceled within 30 minutes after being placed. To cancel an order, you can use the automated Interactive Voice Response (IVR) system or talk to an agent.

Once the order is placed, you will receive an order number. Access to order history is also available in the portal/app. Always keep your order number.

You can use our automated Interactive Voice Response (IVR) system to track an order. If your phone number or email was added to your account, you will also receive email/ text updates. You can also view tracking information through our Over-the-Counter Health Solutions (OTCHS) portal/app.

Items are shipped via USPS to your home at no charge to you. Please allow up to 14 days for delivery.

Call our Behavioral Health Services at 410-424-4476, Monday through Friday from 8 a.m. to 5 p.m.

• Taking a prescription opioid is not the only option for managing pain successfully. You and your doctor should work together to come up with a pain plan. It may include:
  • Understanding how your medications work and how they will impact your body
  • Discussing medication risks with your doctor
  • Learning about non-opioid options, such as:
    • Occupational and/or physical therapy
    • Acupuncture
    • Chiropractic care
    • Stress management or depression treatment
    • Over-the-counter remedies, such as ibuprofen
    • Ice and heat therapy
    • Exercise
    • Massage
  • Staying active in spite of your pain
  • Keeping a pain diary to help guide you and your doctor in managing your pain
  • Identifying a support network
  • Maintaining a healthy diet

• Put all medication away and out of children’s reach and sight.
• Always relock the cap on the medicine bottle.
• Do not share your medication.
• Safely dispose of unused pills.

Sharing prescribed medication is illegal and potentially dangerous. If you have extra unused or unwanted medications, please dispose of them through a Drug Take-Back program.

• Johns Hopkins Medicine participates in yearly drug take back events. Check here for more information about upcoming events.
• Search for year-round pharmaceutical disposal locations by zip code.
• While it’s best to use a Drug Take-Back program or location, most opioids are on the FDA Flush List and may be flushed down the toilet to ensure that they are not accidentally or intentionally ingested, touched, misused, or abused.

Opioids are highly addictive, even when taken as directed. The longer you take them, the more likely you are to become addicted.

There is also a risk of side effects when taking opioids with certain medications. For example, combining an opioid with a benzodiazepine—like alprazolam (Xanax^®), clonazepam (Klonopin^®), or diazepam (Valium^®)—might cause a dangerous drug interaction that could lead to an accidental overdose.

If you suspect that someone has overdosed, please call 911.  You can give the person a medication called Naloxone to reverse the overdose while waiting for a medical response. If you give someone Naloxone, observe them constantly until emergency care arrives to make sure their breathing does not slow or stop. Our formulary includes generic Narcan, a nasal spray containing Naloxone. (You can work with your prescriber or pharmacist to decide the best option for you to have on hand, and check the medication tier by using the formulary search tool.)

Because opioids carry such serious risks, Advantage MD conducts reviews or safety edits whenever a member:

• Receives opioid prescriptions from three or more prescribers and takes a total of 90 Morphine Milligram Equivalents (MME) or more per day,
• Receives prescriptions for both an opioid and a benzodiazepine, OR
• Receives prescriptions for both an opioid and a buprenorphine.

In each of these situations, the pharmacist can override the review or safety edit by consulting with the prescriber(s) to determine the medical necessity of the member’s prescriptions. If the pharmacist is unable or unwilling to override the review or safety edit, the member, member’s representative and/or prescriber can submit a coverage determination.

For members who have not filled an opioid prescription in the past 108 days, we limit their initial opioid prescriptions for treatment of acute pain to no more than a 7-day supply. Pharmacists can override this review by assessing the member’s opioid fill history. The member, member’s representative and/or prescriber can submit a coverage determination to get more than a 7-day supply.

Common prescription opioids include:

• Oxycodone (OxyContin^®, Percocet^®, Roxicodone^®)
• Hydrocodone (Vicodin^®, Lorcet^®, Norco^®)
• Morphine (MS Contin^®)
• Codeine (Tylenol^® with codeine)
• Tramadol (Ultram^®)
• Methadone

The Advantage MD MTM Program is dedicated to providing you with information about safe medication disposal. Medications that are safe for you may not be safe for someone else. Unneeded medications should be disposed of as soon as possible. You can discard your unneeded medications through a local safe disposal program or at home for some medications.

Locating a community safe drug disposal site 

A drug take back site is the best way to safely dispose of medications. To find drug take back sites near you, visit the DEA Controlled Substance Public Disposal Locations website and enter your location.

Some pharmacies and police stations offer on-site drop-off boxes, mail-back programs, and other ways for safe disposal. Call your pharmacy or local police department (non-emergency number) for disposal options near you.

Mailing medications to accepting drug disposal sites 

Medications may be mailed to authorized sites using approved packages. Information on mail-back sites can be found at www.deatakeback.com.

Safe at-home medication disposal 

You can safely dispose of many medications through the trash or by flushing them down the toilet. Learn more about safe at-home disposal.

Follow these steps for medication disposal in the trash:

• Remove medication labels to protect your personal information
• Mix medications with undesirable substances, such as dirt or used coffee grounds
• Place mixture in a sealed container, such as an empty margarine tub

Please contact us if you would like additional information about our MTM program or if you do not want to participate. Call 844-635-3406 (TTY: 711) 24 hours a day, seven days a week.

The targeted medication review is completed by a health care provider who reviews your medications at least once every three months. With this review, we mail, fax, or call your prescriber with suggestions about prescription drugs that may be safer or work better for you. As always, your prescriber will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your prescriber decide to change them. We may also contact you by mail or phone with suggestions about your medications.

By completing the medication review with a health care provider, you will:

• Understand how to safely take your medications
• Get answers to any questions you may have about your medications or health conditions
• Review ways to help you save money on your drug costs
• Receive a Recommended To-Do List and Medication List to keep and share with your prescribers and/or caregivers

Different prescribers may write prescriptions for you without knowing all the medications you take. For that reason, the MTM Program health care provider will:

• Review all your medications
• Discuss how your medications may affect each other
• Identify any side effects from your medications
• Help you reduce your prescription drug costs

You may receive a call from a pharmacy where you recently filled one or more of your prescriptions. You can choose to complete the review in person or over the phone.

A health care provider may also call you to complete your review over the phone. When they call, you can schedule your review at a time that is best for you.

Trusted MTM Program partners: You may receive a call from the CVS Caremark Pharmacist Review Team or the Outcomes Patient Engagement Team to complete this service.

The comprehensive medication review is completed with a health care provider in person or over the phone. This review is a discussion that includes all your medications:

• Prescription drugs
• Over-the-counter (OTC)
• Herbal therapies
• Dietary supplements

This review usually takes 20 minutes or less to complete. During the review, you may ask any questions about your medications or health conditions. The health care provider may offer ways to help you manage your health and get the most out of your medications. If more information is needed, the health care provider may contact your prescriber.

After your review, you will receive a summary of what was discussed. The summary will include the following:

• Recommended To Do List. Your to-do list may include suggestions for you and your prescriber to discuss during your next visit.
• Medication List. This is a list of all the medications discussed during your review. You can keep this list and share it with your prescribers and/or caregivers.
  • Here is a blank copy of the Medication List for tracking your medications

In the MTM Program, you will receive the following services from a health care provider:

• Comprehensive Medication Review
• Targeted Medication Review

If you qualify, we will mail you a letter. You may also receive a call or text to set up your one-on-one medication review.

You will be enrolled in the Johns Hopkins Advantage MD MTM Program if you meet one of the following:

• Have coverage limitation(s) in place for medication(s) with a high risk for dependence and/or abuse, or
• Meet the following criteria:
  • You have three or more of these conditions:
    • Alzheimer’s Disease
    • Bone disease – arthritis (osteoporosis, osteoarthritis, rheumatoid arthritis)
    • Chronic congestive heart failure
    • Diabetes
    • Dyslipidemia
    • End-stage renal disease
    • HIV/AIDS
    • Hypertension
    • Mental health (depression, schizophrenia, bipolar disorder, chronic/disabling mental health conditions)
    • Respiratory disease (asthma, COPD, chronic lung disorders)
  • You take eight or more routine medications covered by your plan
  • You are likely to spend more than $1,623 in Part D prescription drug costs in 2025

Your participation in the MTM Program is voluntary and does not affect your coverage. This is not a plan benefit and is open only to those who qualify. There is no extra cost to you for the MTM Program.

You should share a copy of the decision with your doctor so you and your doctor can discuss next steps. If we make a coverage decision and you are not satisfied with this decision, you or your provider can “appeal” the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. The directions on how to file an appeal are in your notification letter or in Chapter 9 of your Evidence of Coverage.

Your provider is responsible for submitting the prior authorization or step therapy exception request. Your provider is aware of how to submit this request. Once Advantage MD reviews the request, you will be notified of the decision via phone and mail. Please contact your provider to determine next steps.

All preferred and non-preferred Part B drugs are identified on the Advantage MD Part B Prior Authorization List. Look for your drug on the list. If your drug is not listed, it does not require prior authorization. If it is listed as a Preferred Product, it does not require step therapy.

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).

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.

Some medications require prior authorization from your plan before they can be dispensed by your in-network pharmacy. This helps us ensure that your prescriptions are medically necessary. To determine if a medication requires prior authorization, refer to the Pharmacy Formulary specific to your Advantage MD plan. Your physician can request these medications by submitting a prior authorization request. Information about covered medications, medication prior authorization requirements and pharmacy plan benefits are available here.

No. Johns Hopkins Advantage MD (HMO, HMO D-SNP, PPO, PPO Plus, PPO Primary, and PPO Premier) are Medicare Advantage Prescription Drug plans, also known as Medicare Part C. Our contract with CMS allows us to provide you with all the benefits of Original Medicare, plus coverage to help pay for benefits and services that Medicare doesn’t cover. All Advantage MD plans include prescription drug benefits and extras like vision, hearing, dental, and health and wellness programs. (except HMO Tribute which does not include prescription drug benefits).