Pharmacy Information

Understanding Your Drug Coverage

Network Health has partnered with CVS/caremarkTM to make your pharmacy and drug coverage straightforward. Your Network Health ID Card contains information your pharmacy will need to ensure that your pharmacy benefit is used when you pick up your medications. If you ever have problems at the pharmacy, call the number on the back of your ID card.

Pharmacy Network Updates

On January 1, 2020, Network Health will transition to Express Scripts® (ESI) as the pharmacy benefits manager (PBM). ESI has provided pharmacy benefits management for Network Health Medicare members since 2005, saving members money and providing excellent customer service. Medicare members are not affected by this change.

Beginning August 1, 2019, Walgreens pharmacies are in-network for all Network Health members. Some members in southeast Wisconsin may have already had access to Walgreens and that's not changing, but now all members can use Walgreens. If you would like instructions for transferring prescriptions via mobile phone to a Walgreens pharmacy, see this Instruction Sheet. All other pharmacy benefits remain the same until January 1, 2020.

With the PBM change, many large retailers, including Walgreens, Costco, Meijer, Pick ‘n Save, Walmart and Sam’s Club will be in-network through this change. CVS/caremark (including Target) pharmacies will be out-of-network beginning January 1, 2020. 

If you are using a CVS/caremark pharmacy, we recommend transitioning your medications to a different pharmacy as soon as you can. Generally, in-network pharmacies continue to be in-network through the change to ESI, except CVS/caremark pharmacies. If you decide not to transition early, we recommend refilling your prescriptions at the end of December 2019 to cover your medication needs until you can work with your new pharmacy to transfer your pharmacy files.

If you are currently using CVS/caremark for mail order, you can contact ESI as early as January 1, 2020, to establish your mail order services.

You can search the entire updated pharmacy network, both retail and mail order, at Find a Pharmacy starting November 1, 2019.   

Find a Pharmacy

Always use an in-network pharmacy so your prescriptions are covered by your plan. To find in-network pharmacies near you, use our Find a Pharmacy search. You can also go to My Login to access your account and find a pharmacy.

Pharmacy Tools

In addition, when you log into your account, go to My Benefits, then Pharmacy Benefits and you will be taken to the CVS/ caremark portal, where you will find these helpful tools.

  • Refills On-the-Go - Set up and manage your prescriptions from anywhere, anytime. Download the free CVS/caremark mobile app to refill prescriptions on the go.
  • Understand My Plan and Benefits - Learn about your plan's benefits to help you save money. Compare the pricing and coverage differences between filling a medication at a participating local pharmacy and via mail service. You can also explore which brand-name drugs have generic alternatives available.
  • View Prescription History and Personalized Drug Information - View your prescription history and find information about your medications.
  • Ask-a-Pharmacist - Get confidential and reliable answers to your prescription and over-the-counter drug questions.

Find Drug Costs

Network Health has a Comprehensive List of Covered Drugs, which is also referred to as a Formulary or Preferred Drug List. This list contains the drugs that Network Health covers under our health insurance plans. It includes the most commonly covered medications with information about their tier and any restrictions or special requirements.

Use our Look Up Medications tool to search for covered drugs. You can also perform this search in your account by going to My Login for the most accurate information.

Save Money with Mail Order

If you prefer to receive your medications in the mail, you can save time and money by signing up for home delivery. With this service, your prescriptions will be delivered right to your door.

Here’s how to sign-up.

  • Call FastStart® (CVS/caremark Mail Service Pharmacy) at 800-875-0867
  • Or, go to My Login, sign in to your account and go to My Benefits, then Pharmacy Benefits. Select Plan Savings Opportunities on the right side of the page and click the Save with Mail Service Programs button.

Standard shipping is free and your prescriptions should arrive within 14 days of the date CVS/caremark receives your order.

Prescription Drug Claim Form

If you purchased prescription drugs without presenting your ID card (due to an emergency or at non-participating pharmacy of medical facility), complete our prescription reimbursement claim form for consideration of reimbursement from CVS/caremark.

Diabetic Monitoring Devices

Network Health has partnered with OneTouch®  and Accu-Chek to bring diabetic monitoring meters to our members at no cost. If you have an ACA plan purchased through the healthcare exchange, please use the Accu-Chek voucher. All other plans will continue to use the OneTouch voucher. 

 

 

 Frequently Asked Questions

A drug that’s discovered, developed and marketed by a pharmaceutical company. This drug is protected by a patent.
Generic drugs are received and approved by the Food and Drug Administration as having the same active ingredients as their brand name counterparts. That means they work the same as brand name drugs, but can cost up to 80 percent less than brand name drugs. You can save money by asking for generics first.
Like preventive care or services, preventive drugs can help you avoid many illnesses and conditions. As part of your Network Health plan, these drugs cost $0.
Sometimes also referred to as a Formulary or Preferred Drug List, this is a list of covered drugs that includes the most common medications with information about their tier and any restrictions that make exist.
The cost level of a drug. The higher the tier, the more you will pay.

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