Understanding Your Pharmacy Benefit

How to fill your prescription for the first time

Find out if your drug is covered

The fastest and easiest way to find out if your drug is covered is to check to see if your drug is on the lists of covered drugs for your plan. These lists are called formularies.

Check your Summary of Benefits and Coverage (SBC) to determine the formulary for your plan.

View Pharmacy Formularies

Find out what it costs

Not every drug is priced the same. There is a cost share or copay associated with every non-preventive prescription, and the amount you will have to pay is determined by the drug prescribed. When you check your formulary, you’ll see that there are up to four tiers, or levels of drugs. Be sure to check our website each time you need a prescription for the most updated formularies and tiers.

  • Tier 1: Includes most generic drugs, and is the lowest copay.
  • Tier 2: Includes many generic and brand-name drugs, and is the next-highest copay.
  • Tier 3: Includes the most expensive generic and brand-name drugs, and is the highest copay.
  • Tier 4 (optional): When this tier is chosen by employers, this becomes the highest copay tier.

Have your prescription filled via pharmacy or mail-order

You can have your prescription filled either through a pharmacy or, if your drug qualifies, through the mail.

If your prescription has a supply of less than 90 days, you would typically have it filled at a pharmacy. You can go to any of the nearly 68,000 pharmacies that are part of the CVS Caremark network. Just to be clear, the CVS Caremark network includes more than just CVS pharmacies. In fact, the vast majority of pharmacies in the U.S. are part of the CVS Caremark network, including most national retail chains and independent pharmacies.

If your drug is a Tier 4 drug or has a SP designation on the formulary list, you must have it filled at a participating designated speciality pharmacy.

If your prescription is ongoing and has a supply of 90 days or more, such as for a chronic condition like asthma or diabetes, mail order is typically recommended. This option typically saves you money, and you can arrange it so that your medication arrives automatically so you don’t run out.

Be sure you have any necessary approvals in place, then call CVS Caremark Customer Service at 800.581.5300. If your medication doesn’t need approval, you’ll be transferred to CVS Caremark FastStart. Once your account is set up, you can easily order refills online or by phone. Be sure to have the following ready:

  • Your Tufts Health Freedom Plan ID Card
  • Your medication name
  • Your physician’s name and phone number
  • Your shipping address
  • Your credit card

Our goal is to make the Tufts Health Freedom Plan pharmacy benefit simple to use. If you have any questions at all, please don’t hesitate to contact us. We’re here to help.

  1. Tufts Health Freedom Plan’s low-cost generic drug program is not available to some Saver plan members. Please check with your employer for details.