Pharmacies and Formularies

Participating Retail Pharmacies

Thousands of chain and independent pharmacies participate in the Caremark (formerly known as PharmaCare) and Merck-Medco networks. Some Pittsburgh-area pharmacies that participate in both plans include: Costco, CVS, Giant Eagle, K-Mart, Medicine Shoppe, RiteAid, Target, and Wal-Mart.

When you need a prescription filled, present your Caremark/PharmaCare prescription drug card (or your Highmark HMO medical plan card) to the pharmacist, along with your prescription for a month's supply of medication. You'll pay the copay for generic or brand-name drugs. If you do not present your new card at the time of purchase during your first visit, you may be required to pay for the medication in full and later file a separate request for reimbursement.

Caremark/PharmaCare Pharmacy Locator (supported by Internet Explorer only) - find participating pharmacies near you.
- Caremark/PharmaCare Direct Member Reimbursement Form (.pdf) - when using a pharmacy without showing your PharmaCare member ID card.
Merck-Medco / Highmark HMO Pharmacy Locator - Search for a participating pharmacy by zip code.

Drug Formularies

The Formulary Drug List plays a critical role in the success of your prescription benefit plan. The medications included are selected to provide the best therapeutic options to you at the lowest cost.

It's a good idea to take a copy of the Formulary List when you visit your physician. Many pharmacies will alert you when a prescribed drug is not on your formulary. Formularies may be changed by the carrier at any time; Caremark/PharmaCare reviews its formulary quarterly.

Note especially that Caremark/PharmaCare Option B will not cover non-formulary medications unless the Caremark/PharmaCare Prior Authorization Request Form (.pdf) has been completed and approved in advance.

Caremark/PharmaCare Online Formulary List - Use the Preferred Choice Formulary Options. "Non-Formulary Drug and Formulary Alternative(s)" lists drug that are NOT on the formulary, and indicates formulary alternatives that you may want to discuss with your doctors. The "Preferred Choice 2-Tier Formulary Guide" is a partial listing of the most widely prescribed medication on the formulary.
Highmark HMO Online Formulary List

Generic Drugs

All of our plans automatically substitute generic drugs if one exists, unless your physician completes the Caremark/PharmaCare Prior Authorization Request Form (.pdf) in advance to certify that you must take the name-brand drug due to medical necessity. Generic drugs are FDA-confirmed to be pharmacologically equivalent to their name brand counterpart – but are available at substantial savings to you and your plan. If you choose to use the name-brand drug without pre-certification through your prescription plan, you will be charged additional costs. For more information about generic drugs, read the Generic Drugs Q&A.

Related forms:

Caremark/PharmaCare Prior Authorization Request Form (.pdf) - for overriding non-formulary coverage, automatic generic substitution, etc.
Caremark/PharmaCare Prescription Drug Direct Member Reimbursement Form (.pdf)