2027 Pharmacy Update

Please keep in mind that changes to pharmacy benefits may require some adjustment as plans, formularies, and pharmacy networks evolve. 

Below are helpful reminders for the 2027 plan year to help you get the best value from your pharmacy benefits. CVS Caremark also sent letters to members who are affected by formulary or specialty medication changes, so be sure to review any communications you receive.

Formulary Change – There will be a formulary change from the Basic Control Formulary (2026) to the Standard Control Formulary (2027). There will be minimal impact to current medication coverage, but you may use the formulary links provided to compare your medication between the two.

You can expect to receive a letter from CVS Caremark if your current medication will not be on the Standard Control Formulary. That letter will provide alternatives that are covered on the new formulary for you to discuss with your provider. If your provider has already tried the alternatives that are covered, they may submit a prior authorization request to CVS Caremark for consideration of the non-formulary medication.

If your medication is changing from not covered to covered on Standard Control Formulary, you will not receive a letter but rather experience the lower cost shares upon your first pharmacy fill of the medication in the new plan year. 

Any questions on formulary medications, finding a network pharmacy, checking the cost of a specific medication or how your plan works, please contact CVS Caremark at 1 (833) 298-7175.

Lion Advantage – Remember the deductible starts over on January 1 each year – all covered medications (and medical services) are subject to the deductible before being covered – members still receive the benefit of the “allowed amount” versus full retail cost.

Lion Traditional Condition Care Program – Diabetic supplies are covered in full on this plan.  Please review the Diabetic Supply Guidelines for both pharmacy and medical coverage of your diabetic supplies.

Specialty Medications and Prudent Rx – For the Lion Traditional program - for some specialty medications, CVS Caremark uses Prudent Rx (similar to Highmark’s Copay Armor program) that leverages manufacturer coupons.  There is some coordination that needs to occur so anyone having concerns or difficulties should call CVS Caremark at 1 (833) 298-7175.  

Retail 90 – Scripts written for 84- to 90-day supply will be available for direct pick-up from an in-network Retail 90 pharmacy location, without going through a true mail order pharmacy (medications mailed to your home from CVS Mail Order), but still for the mail order coinsurance amount. Please remind your doctor to prescribe the appropriate days’ supply. This new benefit is especially convenient for those whose medications must be refrigerated.  Specialty medications can also be picked up at a Retail 90 location – just stipulate when ordering that you want it sent to a Retail 90 pharmacy; University Health Services (UHS) Pharmacy, CVS Pharmacy, Giant Eagle, Giant, Medicine Shoppe, Rite Aid, Walmart, Sav-On, Costco, Boalsburg Apothecary, Moshannon Valley, and many other independent pharmacies. Please keep in mind that while these pharmacies are in-network for the Retail 90 program, they may choose to fill or not fill certain medications as a 90-day supply based on their business needs. Is it always in your best interest to check with an in-network Retail 90 location before having your script sent in.