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CVS/caremark Formulary Information

Medications Requiring Prior Authorization for Medical Necessity (see below)

CVS/caremark Drug List Information

Preferred Drug List

CVS/caremark Drug List Information for Prescribers

The CVS/caremark Prescribing Guide contains useful information for physicians. This Prescribing Guide is not specific for GEHA participants, however would be helpful information for physicians.

CVS/caremark Prescribing Guide

CVS/caremark Forms

Mail Order Request Form

Paper Claim Form (Direct Reimbursement Form)

CVS/caremark Specialty Drug Information

Specialty Drug List

Medications Requiring Authorization for Medical Necessity

Drug NameForm
1358-E Opioids IR - Combo Acute Pain LimitDownload
1360-D Opioids ER Step TherapyDownload
1361-M Opioids ER MME Limit & Post LimitDownload
1363-M Opioids IR MME Limit & Post LimitDownload
1364-E Opioids IR Acute Pain Duration LimitDownload
Abilify Download
AbstralDownload
ActosDownload
ActiqDownload
Adderall XRDownload
ADHD AgentsDownload
ADHD Agents Post LimitDownload
AdrenaclickDownload
AdvicorDownload
AerospanDownload
Alcortin ADownload
Aloquin.Download
AltoprevDownload
AlvescoDownload
Amerge, Imitrex, Maxalt, Zomig Post LimitDownload
Amitiza Download
AmphetaminesDownload
AmrixDownload
Anaphylaxis TreatmentDownload
AndrogelDownload
Angiotensin II Receptor AntagonistsDownload
Angiotensin II Receptor Antagonists ComboDownload
Anti-Obesity AgentsDownload
AntipsychoticsDownload
Apexicon EDownload
ApidraDownload
AriceptDownload
ArthrotecDownload
Asacol HDDownload
AtacandDownload
Atacand HCTDownload
Autoimmune ConditionsDownload
Avonex Download
Axert Post LimitDownload
Beconase AQDownload
Benefit ReconsiderationDownload
Bensal HPDownload
BetapaceDownload
BiguanidesDownload
Brand Penalty ExceptionDownload
Butalbital APAP Caffeine CapsulesDownload
Bydureon Download
ByettaDownload
Calcium Channel BlockersDownload
Carac Download
Cardizem Download
Cardizem CD Download
Cardizem LA and GenericsDownload
Carnitor/Carnitor SFDownload
Chronic Myelogenous Leukemia AgentsDownload
Cialis 2.5mg and 5mgDownload
Clobetasol Spray Download
ClobexDownload
ColazalDownload
Commercial Appeals – OtherDownload
Compounded Drug ProductsDownload
CorticosteroidsDownload
CrestorDownload
CymbaltaDownload
DaklinzaDownload
DelzicolDownload
Dermatology, MiscellaneousDownload
Detrol LADownload
DexpakDownload
DifferinDownload
Diovan Download
Diovan HCTDownload
Doryx, Doryx MPC, MonodoxDownload
DPP-4 InhibitorsDownload
DPP-4 Inhibitors CombinationsDownload
DuexisDownload
DuleraDownload
DutoprolDownload
DymistaDownload
DyreniumDownload
EdarbiDownload
EdarbyclorDownload
E.E.E. Granules-ErypedDownload
ElelysoDownload
EnablexDownload
EntrestoDownload
Erectile Dysfunction AgentsDownload
EuflexxaDownload
EvzioDownload
ExelonDownload
Exforge Download
Exforge HCT Download
Extavia Download
FabiorDownload
FentoraDownload
Fioricet CapsulesDownload
Fluorouracil cream 0.5% Download
Follistim AQDownload
FortametDownload
Fortesta Download
Fosrenol Download
Frova Post LimitDownload
GelniqueDownload
GenotropinDownload
GleevecDownload
GlumetzaDownload
Growth HormonesDownload
Headache AgentsDownload
HecoriaDownload
Helixate FSDownload
Hepatitis C AgentsDownload
HMG-CoA Reductase InhibitorsDownload
HorizantDownload
HumalogDownload
Humalog Mix 50/50Download
Humalog Mix 75/25Download
Humulin 70/30Download
Humulin NDownload
Humulin RDownload
Imitrex Injectable Post LimitDownload
Imitrex Nasal Spray Post LimitDownload
Incruse ElliptaDownload
Indocin, NaprelanDownload
Initial Benefit Review (NonClinic)Download
Injectable Incretin MimeticsDownload
Insomnia AgentsDownload
Insomnia Agents Post LimitDownload
Insulin Pen NeedlesDownload
Insulin SyringesDownload
IntermezzoDownload
IntunivDownload
Invokamet Download
JalynDownload
JardianceDownload
JubliaDownload
KazanoDownload
KerydinDownload
Klor Con 25Download
Kombiglyze XRDownload
LanoxinDownload
LantusDownload
LastacaftDownload
LazandaDownload
Lescol XLDownload
Lidocaine topical, Lidocaine-Prilocaine, Lidocaine-Tetracaine Post LimitDownload
LidodermDownload
LipitorDownload
LiptruzetDownload
LivaloDownload
Long Acting InsulinsDownload
LumiganDownload
LunestaDownload
MacrodantinDownload
Matzim LA Download
Miacalcin InjectionDownload
Miacalcin Nasal SprayDownload
MillipredDownload
MinocinDownload
Minolira, Solodyn, Ximino Step TherapyDownload
Monovisc Download
MS AgentsDownload
NamendaDownload
NaprelanDownload
Nasal SteroidsDownload
NatestoDownload
NesinaDownload
NeupogenDownload
New to Market Drugs Medical NecessityDownload
NexiumDownload
NilandronDownload
Noritate Download
NorvascDownload
NovacortDownload
Nutropin AQDownload
Nuvigil (FA-PA)Download
NuvigilDownload
Oleptro Download
Olux-EDownload
OlysioDownload
OmnarisDownload
OmnitropeDownload
OnglyzaDownload
OnsolisDownload
Onzetra Xsail Post LimitDownload
Ophthalmic SteroidsDownload
OpsumitDownload
OrthoviscDownload
OseniDownload
Osteoarthritis AgentsDownload
OxytrolDownload
PAH AgentsDownload
PennsaidDownload
PlavixDownload
Plegridy Download
PradaxaDownload
PraluentDownload
PrevacidDownload
Preventive Services Zero Copay ExceptionDownload
PrimlevDownload
Proton Pump InhibitorsDownload
ProtonixDownload
Proventil HFADownload
ProvigilDownload
Prudoxin, Zonalon Step TherapyDownload
QnaslDownload
RayosDownload
RazadyneDownload
RegranexDownload
Relenza Post LimitDownload
Relion InsulinDownload
Relistor Download
Relpax Post LimitDownload
RestasisDownload
Rhinocort AquaDownload
Rimso-50Download
RiometDownload
RozeremDownload
SABAsDownload
SaizenDownload
SNRIsDownload
SolarazeDownload
SprixDownload
Stadol Nasal Spray Post LimitDownload
SubsysDownload
Sumavel DoseProDownload
Sumavel DosePro Post LimitDownload
SymbicortDownload
SynjardyDownload
Tamiflu Post LimitDownload
TasignaDownload
TazoracDownload
TechnivieDownload
TestimDownload
Testosterone GelDownload
Testosterone Oral ProductsDownload
Testosterone Products (FA-PA)Download
Testosterone Products TGCDownload
TevetenDownload
Teveten HCTDownload
Tev-TropinDownload
TOBIDownload
TOBI PodhalerDownload
Topical Corticosteroids (FA-PA)Download
Topical CorticosteroidsDownload
Toujeo Download
ToviazDownload
Tretinoin ProductsDownload
Treximet Post LimitDownload
TricorDownload
TudorzaDownload
Urinary AntispasmodicsDownload
UroxatralDownload
Valcyte Download
ValtrexDownload
Vanoxide-HCDownload
Venlafaxine ext-rel tabletDownload
Ventolin HFADownload
VeramystDownload
Viekira Pak Download
VimovoDownload
VogelxoDownload
XenazineDownload
XiidraDownload
Ximino Step TherapyDownload
Xopenex HFADownload
XtandiDownload
XyremDownload
ZegeridDownload
Zembrace SymTouch Post LimitDownload
ZepatierDownload
ZetiaDownload
ZetonnaDownload
ZonegranDownload
Zubsolv Download

Blood Glucose Test Strips

1. Diabetic Pen Needles and Syringes
2. Diabetic Test Strips - Atypical

3. Diabetic Test Strips
4. Diabetic Test Strips Post Limit

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