Oct 27, 2021
Effective January 1, 2022, Sutter Health Plus is changing their pharmacy benefit manager (PBM) to CVS Caremark® from Express Scripts®. CVS Caremark will manage the pharmacy benefits for members, including retail, mail order and specialty prescription drugs, claims processing, and prior authorization requests for drugs.
CVS Caremark is collaborating with Sutter Health Plus to make sure members get the right prescription drugs at the right time. CVS Caremark is committed to providing high-quality coverage and service while helping manage prescription drug costs.
Sutter Health Plus employer clients are being notified directly of the change by mail on October 29.
Sutter Health is also mailing all active subscribers a letter about the PBM change on November 1. The letter will provide details about the transition, including new mail order and specialty pharmacy vendors, basic information regarding the Sutter Health Plus Formulary, and contact information for CVS Caremark.
The letters include a reference to “Pending Regulatory Approval.” Adding this reference allows Sutter to provide timely notice about the transition to CVS Caremark while the Department of Managed Health Care (DMHC) completes its review of the PBM transition.
To help make sure members can continue to receive their drugs with minimal disruption, Sutter Health Plus is transferring member prescription history, including claims information and any active prior authorizations to CVS Caremark. They are also transferring active and refillable mail order and specialty prescriptions.
For more details about the transition, visit the Sutter Health Plus Pharmacy page.
If you have questions about the new pharmacy benefit manager during the transition, please call Sutter Health Plus Account Services at 1-855-325-5200 or email shpbroker@sutterhealth.org.
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