December 15, 2025
IMPORTANT – DON’T FORGET!
In September, CVS Caremark sent a notification to members whose medications are not on the CVS formulary. A reminder was sent on October 20. The letter explains upcoming coverage changes that may require you to act.
We have also sent communications via the Benefit Basics program. Click HERE to view the latest communication.
If you received a letter, it means you will need to talk to your doctor who prescribed the medication and change it to one of the alternative medications listed in the letter or request medical necessity review to remain on current prescription (see additional details below).
Beginning January 1, 2026, you’ll need to change to a covered medication or be approved for a formulary exception based on medical necessity (see below) to avoid paying the full cost.
Members have only until December 31, 2025, to contact their physician and discuss the needed changes. After this year ends prescriptions for those medications will not be filled.
Don’t wait any longer. Contact your physician now to discuss changing your medication.
What to Do If You Can’t Fill Your Medication After January 1st?
The attached flyer explains the process for handling a rejection of your prescription at a retail pharmacy or if a mail order prescription being filled through mail order was rejected. In both situations Prior Authorization (PA) is required. This will take time and likely create a delay in receiving your medication.
Questions?
If you have questions about the process, the CVS Caremark Customer Care team is available 24 hours a day, seven days a week and can be reached at 1-866-818-6911.
The Bucks and Montgomery County Schools Health Care Consortium
www.bmshc.org
Benefits Basics is intended for distribution to members enrolled in the Bucks and Montgomery County Schools Health Care Consortium insurance plan. The Summary Plan Description available at the website provides full details of all coverage including exceptions and limitations.