CVS Caremark™

Empower Pharmacy Services provides clinical services for Empower members, including the review of pharmacy prior authorization requests. Empower partners with CVS Caremark for prescription claims processing and the pharmacy network.

CVS Caremark and Empower work together to design and manage your pharmacy benefit plan. This includes creating your list of covered medications (also called a formulary), determining how much you will pay for your medication, and providing you with programs and services to help you effectively manage your health. CVS Caremark helps you get the medication you need, when you need it, whether it’s once a month or once a year.

To learn more about your prescription drug benefits, register at Caremark.com to:

  • Review your coverage and annual spending
  • Find opportunities to save
  • See your prescription history
  • Check medication costs
  • Find in-network pharmacies
  • Refill prescriptions
  • Check your mail-order status

Pharmacy Help Line Number: 1 (800) 364-6331

Glossary of Terms

More information coming soon.

Prior Authorization (PA)

Obtaining approval for a particular service or medication before it is provided.

Drug List

A comprehensive list of clinically efficacious and cost-effective drug products, identified and selected by a group of knowledgeable and duly licensed clinicians, to be utilized by the Plan in order to deliver a high quality of care to members while containing costs.

Pharmacy Benefits Manager (PBM)

An entity contracted with PHP to provide pharmacy services (including performing prior authorization evaluations).

AB-Rated Generic

A pharmaceutical product rated in the Federal Food and Drug administration Orange Book as being equivalent to the innovator brand product.

Generic Substitution

Dispensing a generic drug in place of a brand-name medication.

Generic Drug

Chemically equivalent copy designed from a brand-name drug whose patent has expired.

Non-Equivalent Drug Product Formulary

A list of drug(s) for which generic substitution is not required.

Therapeutic Interchange

The dispensing of a drug product different from that which is prescribed, but which is deemed to be therapeutically equivalent to the original product prescribed.

Step-Therapy Protocol

A step-by-step set of directions that identifies the progression of drug therapy from first line therapy to the most aggressive drug therapy.

Pharmacy/Formulary

Arkansas Formulary (List of Covered Drugs) Search Tips: To search for a drug on the Arkansas Formulary click on the above link. Then choose Beneficiary > Tools > Drug Lookup

Pharmacy Forms & Resources

Authorization Forms

Mail Order Forms

Diabetes Supply Formulary

Claim Forms

Medication Informed Consent

Empower Prospective DUR

Compound prescriptions

Compounded prescription claims may be submitted to the Program when multiple ingredients are used in the preparation of the medication provided to the Arkansas Medicaid beneficiary.  Up to twenty-five (25) National Drug Codes (NDCs) may be submitted for compounded prescription claims.  The provider must indicate the metric decimal quantity of each submitted NDC.  The metric decimal quantity field at the header level should reflect the total quantity of the final compounded prescription.  A prescription is only considered a compounded prescription if two or more NDCs are submitted as ingredients on the claim.  If one or more of the ingredients is not payable by the Program, the cost of those non-covered products will not be included in the payment for the claim.  If the pharmacist opts to provide a compounded prescription in spite of the non-coverage of one or more ingredients, the beneficiary is not responsible for the cost of any non-covered ingredients used to prepare the prescription, but only for the applicable co-payment. The provider may submit a Prescription Clarification Code of 08 (in field 420-DK) to accept payment for only the covered ingredients of the compound.  If the Prescription Clarification Code of 08 is not submitted, the program will reject the claim with an error message informing the provider of the non-covered status of one or more ingredients.  The compounded prescription claim, with two to twenty-five ingredients, will count as one claim against the Medicaid beneficiary’s prescription drug benefit limit. Due to provisions set forth in the Omnibus Budget Reconciliation Act (OBRA 90), only the NDC that is dispensed and the quantity of the NDC that is dispensed can be submitted to Medicaid.  If a pharmacy provider is unable to bill according to these guidelines due to software limitations, the vendor should be notified of these requirements immediately.  Any pharmacy that continues to bill compounded prescription claims improperly will be subject to recoupment of the total paid amount of those claims.

 

Pharmacy News

06/28/21 Reinstatement of Pharmacy Edits
03/11/20 COVID-19 and Emergency Declaration Override Procedures
11/05/19 Empower Flu Vaccine Reimbursement
05/17/19 DMS Pharmacy Program Memorandum
04/30/19 Notice: PASSE Pharmacy Update
02/20/19 Empower New Implementation CVS Fax

Division of Medical Services Pharmacy Program Memorandum

02/22/22 UPDATE: AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board January 19 ,2022
01/19/22 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board January 19,2022
10/20/21 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board October 10,2021
08/25/21 Pharmacy Memo
05/26/21 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board April 21, 2021
02/24/21 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board January 20, 2021
11/25/20 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board October 21, 2020
08/26/20 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board July 15, 2020
05/27/20 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board April 15, 2020
02/26/20 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board January 15, 2020
12/31/19 Medication Assisted Treatment (Act 964)
11/27/19 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board October 16, 2019
10/28/19 Arkansas Medicaid Pharmacy Program updates and information
08/28/19 AR Medicaid Prior Authorization Edits Approved at the AR Medicaid DUR Board July 17, 2019