Always be sure to get your prescription refilled before you run out of your medication. If you use mail service, sign up for our free automatic refill and prescription renewal services or refill reminders online at . To learn more, visit Caremark.com or call us toll-free using the number on your Prescription Card. LIMITATIONS Coverage is not provided for the following prescription drug charges: Drugs for which a prescription is not required Drugs for which payment is unlawful where you reside Charges for which you are not legally required to pay Charges which would not have been made if you were not covered by the plan Experimental drugs or drugs labeled: “Caution – limited by federal law to investigational use” A prescription filled in excess of the number specified by the physician or dispensed more than one year from the date of the physician’s order Indications not approved by the Food and Drug Administration Immunization agents, biological sera, blood or blood plasma Therapeutic devices or appliances, including hypodermic needles, syringes, support garments and other non-medicinal substances, excluding insulin Drugs used for cosmetic purposes Tretinoin for individuals over the age of 24. At the age of 25, member requires a Prior Authorization Medication which is taken or administered, in whole or in part, at the place where it is dispensed or while a person is a patient in an institution which operates, or allows to be operated on its premises, a facility for dispensing pharmaceuticals Prescriptions which you are entitled to receive without charge from any workers’ compensation or similar law or any public program other than Medicaid Nutritional or dietary supplements, antiobesity drugs or anorexients Vitamins available without a prescription Fertility oral and injectable Contraceptive Implants (i.e. Norplant) IUDs Cervical Caps Diaphrams Flouride products Paper Claims: If the need ever arises and you don’t have your ID card with you. Your plan allows you to pay for the prescription at the pharmacy and then submit your receipt along with a claim form to the following address (to obtain a claim form, please contact member services at the number provided on the back of your card): CVS Caremark P.O. Box 52136 Phoenix, AZ 85072 Claims not submitted and received by CVS Caremark within twelve months after you receive services will not be considered for payment.
Always be sure to get your prescription refilled before you run out of your medication. If you use mail service, sign up for our free automatic refill and prescription renewal services or refill reminders online at . To learn more, visit Caremark.com or call us toll-free using the number on your Prescription Card. LIMITATIONS Coverage is not provided for the following prescription drug charges: Drugs for which a prescription is not required Drugs for which payment is unlawful where you reside Charges for which you are not legally required to pay Charges which would not have been made if you were not covered by the plan Experimental drugs or drugs labeled: “Caution – limited by federal law to investigational use” A prescription filled in excess of the number specified by the physician or dispensed more than one year from the date of the physician’s order Indications not approved by the Food and Drug Administration Immunization agents, biological sera, blood or blood plasma Therapeutic devices or appliances, including hypodermic needles, syringes, support garments and other non-medicinal substances, excluding insulin Drugs used for cosmetic purposes Tretinoin for individuals over the age of 24. At the age of 25, member requires a Prior Authorization Medication which is taken or administered, in whole or in part, at the place where it is dispensed or while a person is a patient in an institution which operates, or allows to be operated on its premises, a facility for dispensing pharmaceuticals Prescriptions which you are entitled to receive without charge from any workers’ compensation or similar law or any public program other than Medicaid Nutritional or dietary supplements, antiobesity drugs or anorexients Vitamins available without a prescription Fertility oral and injectable Contraceptive Implants (i.e. Norplant) IUDs Cervical Caps Diaphrams Flouride products Paper Claims: If the need ever arises and you don’t have your ID card with you. Your plan allows you to pay for the prescription at the pharmacy and then submit your receipt along with a claim form to the following address (to obtain a claim form, please contact member services at the number provided on the back of your card): CVS Caremark P.O. Box 52136 Phoenix, AZ 85072 Claims not submitted and received by CVS Caremark within twelve months after you receive services will not be considered for payment.
Add-1_2014%20SAWS%20Caremark%20Prescription%20Drug%20Benefits%20Summary.docx