All About Pharmacy

We created this Pharmacy Benefits Member Guide to make it easier for you to understand and get the most from your pharmacy benefit coverage. It will also give you important cost-saving options. Since some plans may differ from others, you'll want to log in to access your coverage documents for details about your specific plan benefits.

• Employer Group Pharmacy Benefit Member Guide – English (PDF)
• Employer Group Pharmacy Benefit Member Guide – En Español (Spanish) (PDF)

Drug Lists

• California HMO 3-Tier Drug List (PDF)
• Preventive Drug List (PDF)

Cost-saving tips

• Choose generic drugs when possible
• Use our mail order pharmacy for maintenance prescription drugs

Maintenance Choice Pharmacy Program

HMO Active Employees & Early Retirees

The Maintenance Choice pharmacy program provides you with more convenience for filling your maintenance prescriptions (medicine taken regularly for long-term therapy or chronic conditions).

Note: this program only applies to filling maintenance medications. You can still fill 30-day non-maintenance prescriptions at any Health Net contracted pharmacy.

How does the program work? After the third fill of a maintenance medication at a network retail pharmacy, you are required to receive future refills (90-day supply) using either the CVS Caremark Mail Service Pharmacy or your local CVS Pharmacy retail location. The choice is up to you; the copayment is the same either way.

You may order your medication one of the following ways:

• Phone: CVS Caremark^® Member Services at 888-624-1139 (TTY: 711) 24 hours a day, 7 days a week.
• Online: Caremark.com
• Mail: Complete the CVS Caremark^® form and send it to the address listed on the form.
  CVS Caremark Forms:
  • CVS Caremark Form – English (PDF)
  • CVS Caremark Form – En Español (Spanish) (PDF)

LAUSD Mail Service Pharmacy^© and Maintenance Choice^® Program Flyer (PDF)

To learn more, please refer to your plan's Evidence of Coverage. Members may also call the number on the back of their member ID card.

HMO Retirees

For certain kinds of prescription drugs, you can use our preferred mail order service – Express Scripts^® Pharmacy. Generally, the drugs available through mail order are drugs that you take on a regular basis for a chronic or long-term medical condition. Drugs NOT available at our mail order service are marked as “NM” (not mailed) in the Medicare Advantage Seniority Plus Drug List (PDF).

Our preferred mail order service allows you to:

• Order up to a 100-day supply of drugs, based on your plan. (excluding our Specialty Tier 5).
• Enjoy free standard shipping, safely and discreetly to your door.
• Save time and make fewer trips to the pharmacy.
• Receive prescription refills and renewals with the Automatic Refill program.

Usually, you can expect to receive your drugs within 10-14 days from the time the mail order service receives your order. It is recommended that you contact the pharmacy 21 days before your current prescription will run out. This will ensure your order is shipped to you in time. If, at any time, your mail order is delayed, you can contact the pharmacy, Express Scripts® Pharmacy or Member Services for help.

You may register for our preferred Mail Order Service by one of the following ways:

• Phone: Express Scripts^® Pharmacy Member Services at 1-833-750-0201 (TTY: 711) 24 hours a day, 7 days a week.
• On-line: express-scripts.com/rx
• Mail: Complete the Express Scripts^® Pharmacy form below and send it to the address listed on the form.
  • Medicare Advantage Seniority Plus Drug List (PDF)
  • Express Scripts^® Pharmacy Mail Order Form (PDF)

Pharmacy Resources

• Find a Pharmacy
• Prior Authorization form (PDF)
• California Prescription Transition form – English (PDF)
• California Prescription Transition form – En Español (Spanish) (PDF)
• Generic vs Brand-Name Drugs information (PDF)