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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.