Nonmaintenance Medication

This page only applies to plan participants enrolled in HealthLink OAP, Coventry Health Care OAP or the Quality Care Health Plan.

Retail pharmacies that contract with CVS/caremark and accept the copayment amount for medications are referred to as network pharmacies. Plan participants who use a network pharmacy must present their ID card/number or they will be required to pay the full retail cost. If, for any reason, the pharmacy is not able to verify eligibility (submit claim electronically), the plan participant must submit a paper claim to CVS/caremark (see the reimbursement process below).

Participants who use the Retail Pharmacy Network (links below) for their nonmaintenance medication will pay the copayment and any applicable pharmacy deductible.

Retail Pharmacy Network

  • The maximum supply allowed at one fill at a retail pharmacy (such as a participating Walgreens or CVS) is 60 days.  Note:  Two copayments will be charged for any prescription that exceeds a 30-day supply. 

  • Plan participants should use the links below to view a list of network pharmacies inside and outside of Illinois.

CVS/caremark Member Portal

Reimbursement

Plan participants who either (1) did not have their eligibility verified at the time they purchased medication or (2) purchased their medication at an out-of-network pharmacy may file a request for reimbursement of eligible charges by filing a CVS/caremark Claim Form / CVS/caremark Claim Form - Spanish.

Use this link to view information regarding maintenance medication networks and copayments. 

Updated 04/30/19