As of January 1, Commonwealth Care Alliance, Inc. (CCA) has switched to a new Pharmacy Benefit Manager (PBM). As a reminder, members will receive a one-time (31-day supply) transition fill within the first 90 days of the member’s eligibility for most medications. You will receive a notification if your patient receives a transition fill (written, electronic or both). Please review your patient records to address any prescription needs and to ensure that prescriptions are sent to in-network pharmacies. Please submit a new prescription or a prior authorization request with all the necessary information to ensure that your patients don’t experience any gaps in their medication.
Please review your patients’ medications using the tools referenced below to ensure that patients have an alternative for any drugs no longer covered. You may also consider submitting a prior authorization for a drug no longer covered.
As a reminder, CCA’s 2025 formularies can be found at ccama.org/provider.
If your patient’s medication requires a coverage determination or prior authorization, forms and resources may be found on CCA’s website: here
We have also developed fact sheets highlighting some of the most frequently prescribed non-covered medications and the alternatives available on our formulary:
For One Care, click here
For Senior Care Options, click here