Benefits Plus

Frequently Asked Questions

Who is Benefits Plus/CVS Caremark and what do you do?
Benefits Plus Inc. is an administrator for CVS Caremark, Inc., a prescription benefit management company. We have been selected by your employer or health plan to make sure that you receive appropriate, cost-effective pharmaceutical care. We administer your prescription benefit program, process your pharmacy insurance claims, and work to reduce the cost of prescription drugs.

By using the Benefits Plus/CVS Caremark card, you can get prescriptions filled at thousands of participating pharmacies throughout the United States and Puerto Rico. Each participating pharmacy has agreed to charge you and your covered family members negotiated prices. The Benefits Plus/CVS Caremark card enables you to receive your prescription by paying only a small copayment or coinsurance amount. Your health plan pays the rest. In most cases, the claim for your prescription is submitted electronically right at the pharmacy -- there is no paperwork for you to fill out.

What's the difference between CVS Caremark and my insurance company or HMO?
CVS Caremark is not an insurance company. We are hired by insurance companies and other health plans -- such as HMOs and self-insured employers -- to administer the prescription component of your medical insurance. We work hand-in-hand with your health plan to provide you with comprehensive health care coverage.

The information printed on my prescription card is wrong. How can I get it corrected?
The information printed on your card -- such as your name, identification number and dependent names -- is provided to Benefits Plus by your employer or health plan. If your card contains wrong information, most likely it is because your plan has incorrect information on file for you. You should contact your benefits office and provide them with the correct information. They will then contact Benefits Plus and a new card will be created for you.

How do I get an additional prescription card for one of my family members?
You can either contact your benefits office and submit the request through them, or click on the Contact Us page on the left and send us an e-mail. Cards are generally mailed to your benefits office and then forwarded on to you. You should be aware that you can get a prescription filled without having the actual prescription card with you. The pharmacist only needs the numbers that are on the card -- not the card itself. If you would like one of your family members -- such as an older child -- to be able to get prescriptions filled by themselves, you can simply write the information from your card on a piece of paper and give it to them.

I lost my prescription card and I need a prescription right away. What can I do?
Usually you can get your prescription filled without the Benefits Plus/CVS Caremark card. Simply give your group number and ID to the pharmacist. If you don't know your group or ID numbers, just give the pharmacist your social security number. He will then call CVS Caremark and -- in most cases -- we can provide him with the information that is needed to fill your prescription. Please let us or your employer know that you need a new card.

Alternately, you can obtain your prescription by paying in full, saving the receipt, and submitting a claim for reimbursement. If you need a claim form, you can get one online by clicking on Forms in the left column or contact your benefits office.

How do I find out which pharmacies will accept my Benefits Plus/CVS Caremark card?
Most major chain and independent pharmacies participate in the various CVS Caremark networks. To see a list of participating pharmacies in your area, click on Pharmacy Listing and Drug Information in the left column. You also can ask your pharmacist if his pharmacy is part of the network for your particular plan. Most likely you will be able to use the pharmacy you regularly patronize.

Can I use my Benefits Plus/CVS Caremark card when I travel out of town?
Yes. The Benefits Plus/CVS Caremark card is accepted at pharmacies in all 50 states and in Puerto Rico.

My pharmacist said my prescription wasn't covered. Why not?
It all depends on your health plan. Most health benefit providers help pay for drugs that treat the most frequently encountered health conditions. If your prescription is not covered, ask your pharmacist or doctor if a similar drug to treat your condition is on the plan. But remember, even if your drug is not covered by your plan, you can still purchase the medication yourself at the pharmacy's normal price.

What's the difference between getting your prescription filled by mail order vs. taking it to the local drug store?
Each approach has its benefits and advantages. When you need medicine right away for a short-term illness, you should have your prescription filled at a retail drug store. Mail service is not appropriate for this situation.

Mail service pharmacy is most appropriate for maintenance medications, which are medicines that patients must take for an extended period or even for the rest of their lives. The benefits of getting a prescription filled by mail order are cost savings and convenience. Our health plans that offer mail service allow you to receive a 90 day supply of your medication for just one payment vs. 30 days at a retail drug store. Also, mail service provides the convenience of having your prescriptions delivered right to your home.

How do I order a prescription by mail?
You can get a mail order form online by clicking on Forms in the left column. You can also contact your benefits office for forms, envelopes, and brochures on the mail order program.

I took my prescription to the drug store and they asked if I wanted a generic substitute. What's the difference?
When a new drug is developed, the company that makes it gets exclusive rights to sell it for a number of years. Once that time is up, by law they must share their rights to sell the drug with other manufacturers. Usually, other companies can offer their version of that drug for less, since they did not have to do the original research and development. These are called "generics." By law, generic drugs must meet the same standards as the original brand-name drug. So you get the same health benefits, quality and safety -- just at a lower price.

What if I don't want to take a generic drug?
You don't have to take a generic drug if you really don't want to. You will still receive coverage under your CVS Caremark plan. However, many plans require you to pay a higher copay amount for the brand name drug. Some plans also require you to pay the difference in price between the brand-name drug and the generic equivalent. Benefits Plus and CVS Caremark encourage all cardholders to use generic drugs whenever they are available. Using generic drugs is an important way that you can help to save money -- for yourself as well as for your health benefit provider -- while ensuring that you receive quality health care. On average, generic drugs can save about half the cost of the equivalent brand-name drug.

Generic drugs are made with the same active ingredient(s) found in the brand-name product. All generic drugs must meet the same manufacturing and testing standards as the brand-name drug and must be approved by the U.S. Food and Drug Administration (FDA).

Why is my copayment amount different for certain drugs?
This could happen for several reasons. Some plans require you to pay a percentage coinsurance amount each time you get a prescription filled rather than a fixed copayment amount. Because your coinsurance is a percentage of the cost of the drug, the amount you pay for each drug will be different.

Some plans have a lower copayment for generic drugs than for brand-name drugs to encourage you to utilize more cost-effective medications. This lower copayment also may apply to drugs that are included on the plan's preferred drug list.

Finally, some plans require you to pay the difference in price between a brand-name drug and its generic version if a generic is available and you request the brand.

I've been taking a certain medication for years, and now my pharmacist says that my plan wants me to take a different one. Why is that?
Your plan most likely is participating in CVS Caremark's Performance Rx program. This program is based on a list of quality, clinically proven drugs used to treat most health conditions. The medications on this list have specially negotiated prices that save your plan money and provide you with the highest standard of health care. Both you and your health plan will benefit if your doctor prescribes a drug from this list.

In some cases, your pharmacist may call your doctor and ask if a drug from the preferred list can be used. The pharmacist will only talk to your doctor if you agree, and the drug store will be paid for the time and effort spent trying to save money for you and your benefit plan. The decision is always up to you and your doctor. If you or your physician choose not to use a drug from the preferred list, you still will receive coverage under your plan. But choosing a treatment that's on the list helps keep your plan's costs under control.

You've told me to contact my benefits office for more information about my CVS Caremark plan. Who is that and how do I contact them?
Every company that works with Benefits Plus has someone who can help answer your questions about the CVS Caremark card and your prescription benefit program. Usually it's someone in the human resources or personnel department. They should have the information about your specific benefits. The written materials you received with your Benefits Plus/CVS Caremark card should include information about the person or department to contact and how you can reach them.