CVS/Caremark Response to Novel Coronavirus (COVID-19)

Updated 3.26.2020

Wednesday, March 25, 2020
CVS efforts to mitigate potential drug shortages and ensure patient access to medications during COVID-19 National Health Emergency

Given the quickly evolving national health emergency, we need to take action to help ensure your plan members have timely, safe access to medication. The steps being taken to help prevent stockpiling and gaps in therapy, including implementing quantity limits and extending prior authorizations, are outlined below.

Extending Prior Authorizations to Maintain Member Access

During this unprecedented time, it may be more challenging for members to see their prescribers – either because of decreased availability of appointments or personal concern overexposure. In order to prevent gaps in therapy, we are extending many clinical prior authorization records – set to expire between March 23 and June 30 – for 90 days. For instance, if a prior authorization is set to expire on May 15, the expiration date will be extended to August 15.

There are certain medications to which this will NOT apply: short term or one-time use medications, or related to opioid or hypnotic quantity limits

Preventing Potential Shortages of Key Drugs:

While there is no evidence at this time of widespread shortages, it is important to ensure that members with ongoing needs can maintain access to medications, while also enabling patients with COVID-19 to obtain treatment. Some of the medications being identified as possible treatments for COVID-19 are also used by members to treat existing conditions like HIV and lupus.

Beginning immediately, we are introducing a utilization management (UM) product bundle, which will institute quantity limits on medications that potentially treat COVID-19 and are used by members for other conditions.

Albuterol Meter Dose Inhalers:

  • A quantity limit will be added to albuterol inhalers, limiting them to two per 30 days (200 inhalations per device) at retail or six per 90 days at mail
    • These changes apply only to inhalers and not nebulizer solutions or oral tablets
    • These limits are already commonly used by many of our clients and included in some of our formulary designs

Chloroquine, hydroxychloroquine, Kaletra and azithromycin:

A quantity limit will be added to limit the supply dispensed of these drugs:

  • Chloroquine, hydroxychloroquine: 10-day supply, limit of one fill per 60 days
  • Kaletra: 14-day supply, limit of one fill per 60 days
  • Azithromycin 250 mg tablets, limit of 6 tablets or one blister pack of 6 tablets per five days; limit of one fill per 60 days
  • Members are limited to one fill of each product per 60 days

These limits will apply to claims from all pharmacies. While these medications may be useful in reducing the duration of COVID-19 and CVS wants to ensure appropriate member access for that purpose, it is important to ensure access for members using these medications to treat chronic conditions as well.

To minimize disruption for members currently taking these medications, CVS is implementing the following adjudication logic to identify diagnosis and previous utilization to bypass this limit:

  1. If a member has filled a 30-day supply within the previous 180 days, the claim will bypass the quantity limit.
  2. If the claim comes through with an appropriate non-COVID-19 diagnosis code, including lupus, rheumatoid arthritis (RA) or HIV, the claim will bypass the quantity limit.

If a member does not have: a claim history for these drugs OR a diagnosis code indicating lupus, RA or HIV, the quantity limit will apply. Prescriptions exceeding the quantity limits or with no diagnosis code will require prior authorization to confirm appropriate use.

Please note that there is no opportunity to opt-out of these enhancements at this time.

The situation is evolving rapidly as results from various clinical trials and case studies become available, and CVS will continue to evaluate the information and update the requirements as appropriate. Quantity limits and included medications will be automatically updated to stay in line with current clinical guidelines and marketplace conditions.

This is an uncertain time and we understand that your clients and your members are concerned about being able to obtain needed medications. We remain focused on ensuring plan members have timely, safe, and appropriate access to their medications – a service that’s more important now than ever.

Friday, March 13, 2020
CVS Health to Assist with COVID-19 Testing

Given CVS/Caremark’s physical presence in communities across the country and ability to reach millions of consumers with local solutions, they’re in a unique position to help address the COVID-19 pandemic. CVS Health is working with the administration and other partners to help facilitate COVID-19 testing with a common goal of increasing frequency and efficiency.

While details are still being worked out based on the number of tests available and geographic needs, it’s important for CVS Pharmacy customers to understand that they won’t be impacted. CVS expects testing will take place in secure areas of parking lots at select stores – not inside – and individuals being tested will not have to leave their cars. We will share more details as they become available.

Thursday, March 12, 2020
New CVS/Caremark Measures to Help Control the Spread of Coronavirus

Dear Valued Client:

As your partners in health, RxBenefits and CVS/Caremark are partnering to implement active measures to help you control the spread of the coronavirus (COVID-19). We are pleased to announce two new policies that will make it easier for members to access maintenance medications and keep an ample supply on hand, should they need to self-quarantine now or in the near future, per guidance from the CDC and other US health officials.

  1. CVS/Caremark is waiving early refill limits (refill too soon) on 30-day prescriptions for maintenance medications, at any in-network pharmacy
  2. CVS/Caremark and RxBenefits strongly recommend that all members take advantage of this waiver and refill all 30-day maintenance medications now
  3. CVS/Caremark will be waiving charges for home delivery of all prescription medications

Click here to view the full CVS/Caremark announcement.

This is a rapidly evolving situation which we continue to monitor closely. As new information unfolds, we will keep you informed on any new details that impact your pharmacy benefits plan.

Please reach out to your account management team with any questions you may have.

Client Services | 866.769.5987 
clientservices@rxbenefits.com

Member Services | 800.334.8134
rxhelp@rxbenefits.com

Tuesday, March 10, 2020
Additional COVID-19 Resources to Increase Medication access to Medications

On March 9, 2020, CVS Health announced additional COVID-19 resources to increase patient access to medications.

Beginning immediately, CVS Pharmacy will waive charges for home delivery of prescription medications, which will help patients avoid visiting their local CVS Pharmacy for refills or new prescriptions.

CVS Caremark is working with all PBM clients to waive early refill limits on 30-day prescription maintenance medications.

Monday, March 9, 2020
Product & Medication Supply

CVS/Caremark is working with their suppliers to meet customer demand for products being sought in relation to the COVID-19 outbreak. This demand may cause temporary shortages for certain products at some store locations and CVS will re-supply those stores as quickly as possible.

CVS/Caremark is also closely monitoring the global manufacturing environment. They do not see any disruptions to the supply chain that will affect their ability to fill prescriptions for plan members, now and into the near future.

In addition, the Food and Drug Administration is closely monitoring medications that are made in China or rely solely on active pharmaceutical ingredients from China. The agency said it has reminded more than 180 manufacturers to notify the FDA of any potential supply chain disruptions.

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