Sutter Health Plus Newsroom

Timely information for members, brokers, employers, and the community.

Important Information About New Pharmacy Benefit Manager

Posted by on Dec 1, 2021 in Access, Network


On January 1, 2022, Sutter Health Plus is changing its pharmacy benefit manager (PBM) to CVS Caremark®. CVS Caremark will manage the pharmacy benefits for our members, including retail, mail order, and specialty prescription drugs, claims processing, and prior authorization requests. This change is pending regulatory approval by the Department of Managed Health Care.

While Sutter Health Plus and CVS Caremark are working to ensure minimal disruptions during this transition, there are a few things members should know.

New Member ID Cards
Sutter Health Plus members will receive new member ID cards with updated prescription benefit information. Members will need to present their new ID card at the pharmacy for any prescriptions filled on or after January 1, 2022. The pharmacist needs the information on the back of the card, including Rx Group, Rx BIN, and Rx PCN to process prescriptions and submit claims for coverage. Member ID cards will also be available through the Member Portal on or before January 1, 2022.

Current Retail Prescriptions
Sutter Health Plus is transferring members’ prescription history, including claims information and any active prior authorizations, to CVS Caremark. This will allow our members to continue their current retail prescriptions with minimal disruption.

The CVS Caremark retail pharmacy network includes most major pharmacy retail chains and independent pharmacies, including CVS, Rite Aid, Walgreens, Bel Air, Raley’s, and Safeway.

Mail Order Pharmacy
Sutter Health Plus members will have their active and refillable prescriptions transferred to the CVS Caremark mail order provider, CVS Caremark Mail Service Pharmacy. CVS Caremark Mail Service Pharmacy will not mail the first refill automatically. Members must call 1-844-740-0635 or visit caremark.com (registration required) on or after January 1, 2022, to provide their billing information.

CVS Caremark Member Portal
In January, members can create an account on the CVS Caremark member portal at caremark.com, allowing them access to:

  • View order and drug history
  • Order refills online
  • Automatic refill reminders for all of prescriptions (retail, mail order, specialty)
  • Set communication preferences, for example email or text
  • Check order status and track shipments
  • Delivery of drugs within the United States, Monday through Friday, at no additional charge with most supplies provided, e.g., needles and syringes
  • Safety checks to help prevent interactions with other drugs and products
  • Access to specialty-trained pharmacists and nurses 24 hours a day, 7 days a week
  • View claims information

For questions, call Sutter Health Plus Member Services weekdays from 8 a.m. to 7 p.m. at 1-855-315-5800. CVS Caremark Customer Care is also available 24 hours a day, 7 days a week, including holidays by calling 1-844-740-0635.

An Update on COVID-19 Booster Shots

Posted by on Nov 23, 2021 in Access, COVID-19

The Centers for Disease Control and Prevention (CDC) released updated Pfizer and Moderna COVID-19 booster shot recommendations for all individuals age 18 and older.

This new guidance expands booster eligibility to all individuals age 18 and older who completed their initial Pfizer and Moderna COVID-19 vaccine series at least six months prior. This is in addition to the previous recommendation issued for all individuals age 18 and older that received a Janssen/J&J vaccine two or more months ago.

A booster shot is given to individuals when the immune system response to the primary vaccine series has likely decreased over time. This is positive news for people seeking additional protection against COVID-19 ahead of holiday gatherings.

COVID-19 Appointments
Sutter Health Plus covers COVID-19 vaccines for our members, including additional doses or booster shots, even when administered out-of-network. Vaccinations are offered at multiple locations across the Sutter Health Plus service area. Members can check appointment availability through:

  • Network pharmacies
  • The Sutter Health COVID-19 Vaccine appointment line at 844-987-6115
  • Sutter’s patient portal, My Health Online
  • My Turn, California’s COVID-19 vaccine scheduling portal

Proof of COVID-19 Vaccination and Test Results
Members who received their COVID-19 vaccination(s) or testing with Sutter can view and share proof of their COVID-19 vaccination(s) or test results easily from My Health Online. After signing in, members can click the Menu button, scroll to My Record and select COVID-19 to view details. Visit Sutter’s COVID-19 Vaccine Resources page for more information.

Additionally, all members can go to California’s Digital COVID-19 Vaccine Record site to get a link to a QR code and digital copy of their COVID-19 vaccination record.

Safety Protocols
With the increasing vaccine eligibility and supply, the total number of eligible Californians (age five and older) fully vaccinated against COVID-19 now tops 67%, according to the state.

To maximize protection from COVID-19 and prevent possibly spreading COVID-19 to others, the CDC still recommends wearing a mask indoors in public settings—regardless of vaccination status.

Additional Resources
For up-to-date information about COVID-19, visit:

New Pharmacy Benefit Manager Coming in 2022

Posted by on Nov 8, 2021 in Access, Network


Effective January 1, 2022, Sutter Health Plus is changing its pharmacy benefit manager (PBM) to CVS Caremark® from Express Scripts®. CVS Caremark will manage the pharmacy benefits for our members, including retail, mail order and specialty prescription drugs; claims processing; and prior authorization requests for drugs.

CVS Caremark is collaborating with Sutter Health Plus to make sure our members get the right prescription drugs at the right time. We are confident that CVS Caremark will provide high-quality coverage and service while helping manage prescription drug costs.

In early January 2022, members will be able to create an individual account on the CVS Caremark member portal at caremark.com for access to many tools to help them understand the formulary and cost share options, including:

  • View order and drug history
  • Order refills online
  • Automatic refill reminders for all of prescriptions (retail, mail order, specialty)
  • Set communication preferences, for example email or text
  • Check order status and track shipments
  • Delivery of drugs within the United States, Monday through Friday, at no additional charge with most supplies provided, e.g., needles and syringes
  • Safety checks to help prevent interactions with other drugs and products
  • Access to specialty-trained pharmacists and nurses 24 hours a day, 7 days a week
  • View claims information

Teams across Sutter Health Plus and at CVS Caremark are currently collaborating with the goal of ensuring this transition is as seamless as possible for members. For more detail about the transition, visit the Sutter Health Plus Pharmacy page.

About CVS Caremark
CVS Caremark is one of the largest PBMs in the United States and serves over 105 million members across all 50 states, Puerto Rico, and the Virgin Islands. Learn more at caremark.com.

COVID-19 Vaccinations for Children Ages Five to 11

Posted by on Nov 5, 2021 in Access, COVID-19

The Centers for Disease Control and Prevention (CDC) recommends the Pfizer pediatric COVID-19 vaccine for children ages five to 11—a population of more than 28 million in the United States. This is long-anticipated and welcome news for many parents with school-age children.

COVID-19 Vaccine Eligibility and Appointments
COVID-19 vaccine eligibility now includes all individuals age five and older. Currently, children ages five and older are able to get an age-appropriate dose of the Pfizer COVID-19 vaccine. Parental or guardian consent is required.

Vaccinations are offered at multiple locations across the Sutter Health Plus service area. Initial pediatric vaccine appointment availability at Sutter may be limited. Members can check appointment availability through:

  • Network pharmacies
  • The Sutter Health COVID-19 Vaccine appointment line at 844-987-6115
  • Sutter’s patient portal, My Health Online
  • My Turn, California’s COVID-19 vaccine scheduling portal

As a reminder, Sutter Health Plus covers COVID-19 vaccines for our members, even if administered out-of-network.

Safety Protocols
To maximize protection from COVID-19 and prevent possibly spreading COVID-19 to others, the CDC still recommends wearing a mask indoors in public settings—regardless of vaccination status. At this time, it’s important to remain vigilant and follow public health guidelines.

Additional Resources
For up-to-date information about COVID-19, visit:

Open Enrollment for Individuals and Families

Posted by on Nov 1, 2021 in Access, Network


Each fall, thousands of Northern Californians have the opportunity to shop for health insurance for themselves or their families. It’s the only time of the year—other than when special circumstances permit—when they can select new coverage.

This year’s annual open enrollment period begins Nov. 1, 2021 and ends Jan. 31, 2022. During open enrollment, take time to review your insurance options and find a plan that fits your needs or the needs of your family.

“Sutter Health Plus delivers value to its members by offering affordable plans with access to a Northern California provider network focused on achieving better health outcomes,” said Rob Carnaroli, vice president of Sales at Sutter Health Plus. “We offer the coverage and access to high-quality care people expect—and deserve—from a health plan.”

With Sutter Health Plus, members enjoy convenient features, such as access to Sutter Walk-In Care, video visits, a 24/7 nurse advice line, health coaching programs, an online self-service portal, and a single number to call for assistance with many aspects of care and coverage. The Sutter Health Plus provider network in the greater Sacramento, Central Valley and Bay Area communities includes many of Sutter’s physician groups and hospitals that consistently rank among California’s highest performers. Many network providers use the Sutter Electronic Health Record to instantly review and share critical information with other Sutter clinicians allowing them to deliver highly coordinated care.

Get started today by visiting sutterhealthplus.org/individual-family to view Sutter Health Plus’ service area, plans and rate guides, and read detailed benefit information. It’s coverage that’s got you covered.

If you have questions about Sutter Health Plus, Member Services is available weekdays from 8 a.m. to 7 p.m. at 855-315-5800.

An Update on COVID-19 Booster Shots

Posted by on Oct 28, 2021 in COVID-19, News

The Centers for Disease Control and Prevention (CDC) released booster shot recommendations for individuals age 18 and older in certain populations. A booster shot is given to individuals when the immune system response to the primary vaccine series has likely decreased over time.

For individuals who received a Pfizer or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot at six months or more after their initial series:

  • Individuals age 65 years and older
  • Individuals age 18 and older who live in long-term care settings
  • Individuals age 18 and older who have underlying medical conditions
  • Individuals age 18 and older who work or live in high-risk settings

The CDC recommends boosters for people age 18+ who received the Janssen/J&J vaccine two or more months ago.

Initial Vaccines, Additional Doses, and Booster Shots
In addition to the COVID-19 initial vaccine, there are additional doses and booster shots. The terms “additional dose” and “booster shot” aren’t interchangeable. Please refer to the following to better understand the differences between the initial vaccine, an additional dose, and a booster shot.

As of 10/27/21

COVID-19 Appointments
Sutter Health Plus covers COVID-19 vaccines for our members, including additional doses or booster shots, even when administered out-of-network. Please note the following about initial vaccine, additional dose, and booster shot appointments:

  • Initial Dose Vaccine Appointments: If members have not yet received their initial COVID-19 vaccine series, they can schedule an appointment by phone at 844-987-6115 or book online through My Health Online. Members can also sign up on My Turn, California’s COVID-19 vaccine scheduling portal, for available vaccination appointments.
  • Additional Dose Appointments: In accordance with established guidance, Sutter is offering additional doses of Pfizer or Moderna. Eligible individuals can call (844) 987-6115 or sign in to My Health Online to book an additional dose appointment.
  • Booster Shot Appointments: Sutter is now scheduling appointments for Pfizer or Moderna booster shots. Eligible individuals can schedule a booster appointment by calling (844) 987-6115 or by checking My Turn for available appointments. Booking through My Health Online is coming soon. For Janssen/J&J booster shots, individuals can check nearby pharmacies or My Turn for available booster vaccine appointments.

Safety Protocols
With the increasing vaccine supply, the total number of eligible Californians fully vaccinated against COVID-19 now tops 72%, according to the state.

To maximize protection from COVID-19 and prevent possibly spreading COVID-19 to others, the CDC still recommends wearing a mask indoors in public settings—regardless of vaccination status.

Additional Resources
For up-to-date information about COVID-19, visit:

Ways to Manage Stress

Posted by on Oct 13, 2021 in Access, Health and Wellness


Stress is a normal part of life—from rushing to arrive somewhere on time to more serious, potentially life-changing situations. The good news is our bodies are designed to handle the physical, emotional, and mental responses we have to most stressful events. In fact, some stress may even be useful to improve alertness, provide motivation, and add a burst of energy to optimize our performance, according to researchers at UC Berkeley. But if left unmanaged, constant stress can have negative effects on health and may lead to long-term issues like heart disease, high blood pressure, diabetes, and depression or anxiety.

It’s important to know these signs of stress:

  • Feelings of fear, anger, sadness, or frustration
  • Headaches and skin irritations
  • Upset stomach or reduced appetite
  • Difficulty sleeping
  • Problems concentrating
  • Increased substance use

If stress becomes overwhelming, consider making a few positive life changes to address and potentially remove stressors. First, determine why it’s important to make a change, such as improving mood, sleeping better, protecting your heart, or increasing general wellness.

Next, identify the causes of stress. For some, stress can be caused by uncertainty or lack of control in life, financial insecurity, difficulties in personal relationships, balancing career responsibilities with personal obligations, caring for others, or experiencing a major life disruption.

After understanding the causes of stress, set a few reasonable long-term and short-term goals for positive lifestyle adjustments. This might look like spending more time with loved ones, doing the activities that make you happy more often, getting more rest, eating a healthier diet, and exercising regularly. Start small by doing one new thing each day, like waking up 30 minutes earlier, walking for 15 minutes after lunch, or limiting screen time before bed.

To help manage daily stress in the moment, try these intentional techniques to avoid, re-set, and refresh:

Stop and Breathe: Deep breathing signals the body that it’s okay to relax muscle tension and slow the heart rate, which occurs during the body’s natural “fight or flight” reaction to stress. Moments of quiet mindfulness, like meditation, can also provide an intentional break and calm the mind.

Practice Gratitude: Acknowledging and being grateful for the goodness in life can help boost feelings of optimism, joy, and other positive emotions, inspiring a sense of contentment, happiness, and mental well-being.

Say no: Taking on too much can be a stressor. It’s okay to say “no” to commitments, projects, and stressful situations and to release expectations of perfection from yourself and others.

Digital detox: Limit screen time and consumption of news and social media. Take breaks from devices at meals, during outings with family and friends, and at least a half-hour before bedtime.

Reach Out for Help: While experiencing some stress in life is common, worrying or becoming overwhelmed every day should be discussed with a provider. Working with a behavioral health professional can help to gain control over anxiety and better manage stress.

Sutter Health Plus members may self-refer for an in-person or virtual visit with a participating behavioral health provider through U.S. Behavioral Health Services (USBHPC) by calling 855-202-0984 or visiting liveandworkwell.com. Sign in or browse as a guest with company access code “Sutter” to access a variety of stress management articles, videos, tools, and resources.

For 24/7 support, members have premium access to Sanvello—a top-rated app offering daily mood tracking, coping tools, guided journeys, and clinical techniques to help with symptoms of stress, anxiety, and depression—at no cost through USBHPC. Learn more here and download the free Sanvello app from the App Store or Google Play.

Members also have access to a Health Coaching Program for stress management at no cost share. Participants work one-on-one with a trained personal health coach to uncover barriers to self-management, link behavior to personal values, and set goals to make healthier lifestyle choices. To learn more, call the coaching team at 866-961-8513 or visit sutterhealthplus.org/wellness.

There is also a Health and Wellness site available through the Member Portal that provides stress management and health-related resources, a personal health assessment, action plan modules, a video library, a symptom checker, and more.

For detailed information about behavioral health benefits, members can review their Evidence of Coverage and Disclosure Form found on the Member Portal or call Member Services weekdays, 8 a.m. – 7 p.m. at (855) 315-5800.

Sources include Centers for Disease Control and Prevention, National Institute of Mental Health, and UC Berkeley News.