October 28, 2025
Reminder for Members who received a
Take Action Letter from CVS Caremark
In September, CVS Caremark mailed letters to those members who may be taking a medication or product that is not on the CVS formulary. A reminder letter was mailed by CVS on October 20th to all impacted members. The letter states: We’re writing to let you know about upcoming changes to your medication coverage that will require you to take action.
The CVS Caremark formulary covers a specific list of medications. 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).
IMPORTANT
Time is running out. If you have not already changed your medication or if your doctor has not requested a formulary exception based on medical necessity you need to call CVS Caremark at 1-866-818-6911 to request a legacy period extension through December 31, 2025. If you do not call or take action, it is possible that your prescription will not be filled.
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.
What if my doctor tells me I need to stay on my current medication?
If your doctor tells you there is a medical necessity to stay on your current medication, your doctor will need to submit the required documentation to CVS for a medical necessity review and request for a formulary exception. All required medical necessity override documentation is due to CVS no later than December 31, 2025.
CVS will make the final determination of approval or denial based on the supporting medical documentation provided by your physician. A request for medical necessity review, does not guarantee a formal approval. It will be important for you to remain in contact with your physician and CVS during this process.
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.