Pharmacy Information and Programs
Your Pharmacy Benefits
Below you’ll find information about your pharmacy and drug coverage.
Explanation of Benefits
When you use your prescription drug benefits, we will send you an Explanation of Benefits (EOB) statement in the mail. This is for your Medicare prescription drug coverage (Part D). Your EOB shows:
- The prescriptions you filled.
- What we paid.
- What you and others have paid.
- What counts towards your Out-of-Pocket Costs and your Total Drug Costs.
Your EOB is not a bill.
If you paid a copayment or coinsurance for your drug, the EOB should show the amount you paid.
You may not get an EOB every month
When we get a claim (bill) from your pharmacy, you’ll get an EOB the next month. For example, if we get a claim in March, you’ll get an EOB in April.
Look over your EOB
Check your EOB to make sure everything is correct. If you have questions, find mistakes, or suspect fraud, we’re happy to help. Call us.
Search for Covered Drugs
CCCA covers a wide range of both over-the-counter, brand name, and generic prescription drugs. This is at no cost to you. Find out if a medication is covered under your plan. Learn more about what to do when it’s not.
Coverage Determinations and Redeterminations
For some drugs, you will need to get approval before we can agree to cover it. This is called prior authorization. If you do not get this approval, your drug might not be covered.
2027 CCA Senior Care Options – Prescription Drug Coverage Determination Request Form
2026 CCA Senior Care Options – Prescription Drug Coverage Determination Request Form
CCA Redetermination Form
If your request for coverage for a prescription drug was denied, you have the right to ask for an appeal of our decision within 65 days of the Notice of Denial.
2027 CCA Senior Care Options – Request for Redetermination of Medicare Prescription Drug Denial
2026 CCA Senior Care Options – Request for Redetermination of Medicare Prescription Drug Denial
If you’ve been prescribed a drug that’s not on the formulary (or “drug list”) you may still be able to get a temporary supply of the drug; request a similar drug that’s on the formulary; or ask the plan to grant an exception or otherwise remove restrictions. Refer to the transition process document based on the plan you’re enrolled in below.
2027 Transition Process for CCA Senior Care Options (HMO D-SNP)
2026 Transition Process for CCA Senior Care Options (HMO D-SNP)
Prescription Fills
Show your CCA member ID card when you get your prescription filled. Make sure your pharmacy is in our network first.
There are some cases when we will cover prescriptions filled at an out-of-network pharmacy. Some examples are when you travel, if you need urgent or emergency care, or if a network pharmacy or drug is not available. You will need to fill out the Prescription Reimbursement Form.
Before filling your prescription at an out-of-network pharmacy, call Member Services. They’ll help you see if there is an in-network pharmacy where you are.
Drug Recalls
We are committed to protecting the health and safety of our members. We monitor alerts from the U.S. Food and Drug Administration (FDA) about drug recalls and withdrawals. We will notify you and your prescriber if we learn of potential problems with a medication.
A drug recall is when a medication or an over-the-counter product is removed from the market. A company may recall a product, or the FDA may require a recall. The FDA helps make sure recalls are handled safely.
A drug may be recalled for many reasons. This can include safety concerns, labeling issues, or problems with the way it was made.
Do not stop taking your medication until you talk to your doctor. In some cases, stopping a medicine too quickly can make your symptoms come back. In some cases, it can cause serious health problems. Follow these steps:
- Call your doctor. Talk about your options.
- Call your pharmacy. Ask about substitutes. For example, they may be able to get the same medication from a different drug company. If not, they can contact your doctor to switch to another drug.
Visit the FDA website1 to learn more. You can also sign up to get alerts on drug recalls.
Find a Pharmacy
You can fill your prescriptions at any pharmacy in our network. Ask your pharmacist if they’re in the Commonwealth Care Alliance network.
Pharmacy Programs
CCA offers no-cost pharmacy programs and services to support you.
The CVS Caremark® Mail Service Pharmacy Program lets you get prescription drugs by mail. The pharmacy will call before sending your prescription. If they can’t reach you, the prescription will not be mailed. Most prescriptions arrive within 14 days.
If you do not get your prescription within this time, or have any issues, call us. To learn more about mail-order pharmacies, check your Member Handbook.
How to sign up:
- Online: Caremark.com
- Phone: 1-866-610-2273 (TTY: 711), 8 a.m. to 8 p.m., 7 days a week.
- Mail: Download and complete the mail order form and send via mail to:
CVS Caremark
P.O. BOX 659541
SAN ANTONIO, TX 78265-9541
Mail Order Pharmacy Form
Use this form to get a CVS Caremark Mail Service Pharmacy account.
Get your specialty medications shipped to your home.
Call Member Services for a list of specialty pharmacies.
You can get a 102 and 90-day supply of certain medications you take regularly for chronic conditions. Members enrolled in the 2026 plan can get a 100-supply. A longer supply may mean fewer trips to the pharmacy.
Some pharmacies only provide a 31-day supply. Ask your pharmacy about its policy.
CCA can help you fill all your medicines on the same day. This is called medication synchronization, or “med sync.” This may help you take fewer trips to the pharmacy.
Medication Therapy Management (MTM) Program
Medication Therapy Management (MTM) is a service we offer at no cost to you. This program helps you and your provider make sure that your medications are working to improve your health.
The MTM program is for Medicare Part D members. To qualify, you must:
- Have filled at least eight Part D medications.
AND
Have at least three of the chronic conditions listed below:
- Alzheimer’s Disease
- Bone Disease-Arthritis (including Osteoporosis, Osteoarthritis, and Rheumatoid Arthritis)
- Chronic Congestive Heart Failure (CHF)
- Diabetes
- Dyslipidemia
- End-Stage Renal Disease (ESRD)
- Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV / AIDS)
- Hypertension
- Mental Health (including Depression, Schizophrenia, Bipolar Disorder, and Chronic / Disabling Mental Health Conditions)
- Respiratory Disease (including Asthma, Chronic Obstructive Pulmonary Disease (COPD), and Chronic Lung Disorder)
AND
Be likely to spend $1,276 in 2026 or $1,340 in 2027 for covered Part D medications.
- All at-risk beneficiaries (ARBs) as defined in 42 CFR § 423.100, even those who do not meet the criteria above, are eligible for CCA’s MTM program.
If you qualify, the MTM program can help you use your medicines safely at no cost.²
Our MTM program helps you:
- Take your medicines the right way.
- Take your medicines as directed.
- Use your medicines safely together.
If you qualify for the program, you will be enrolled in the program. You’ll also get a letter in the mail or a phone call.
You will review your medicines with a clinician during your first visit. This is called a Comprehensive Medication Review (CMR).
Your MTM clinician will work with you and your doctor to help address any problems found during the review.
The CMR includes three parts:
- Medicine Review. We review your medicines to look for possible issues. This may be done in person or by a qualified provider behind the scenes.
- Annual Meeting. Then, we’ll schedule a meeting every year. This is usually a phone call. It takes about 45 minutes to an hour. We will go over all the prescriptions, over-the-counter (OTC) medications, herbal therapies, and dietary supplements you are taking. This helps us find and address any problems or concerns.
- Written summary. After the meeting, you’ll get a written summary. It will include a summary of what was talked about. It will also list the next step you should take. You should receive it within two weeks after your CMR.
How to get started
You do not need to do anything to join the program. Someone from CCA will contact you if you qualify.
To prepare for your CMR, you may complete the Personal Medication List below.
Best Available Evidence Policy
This CMS policy requires CCA to tell CMS when evidence shows that a member’s low-income subsidy (LIS) status may be incorrect in CMS records. For more information, visit the CMS website.1
1 When you click this link, you will leave the Commonwealth Care Alliance website.
2 This program is not a benefit; therefore, if you qualify for our program based on our criteria, we will automatically enroll you in the program and offer you program services over the phone or send you information by mail. The MTM program is free of charge to eligible members. Program participation is voluntary.
