Medication Center

For general information on medications (side effects, storage concerns, drug interactions, and the benefits of prescribing generics), you may visit www.caremark.com.

Commercial Formulary

Capital Health Plan encourages the use of generics as the first-line of prescribing. Generic medications are the lowest-cost options to our members and are available at a Tier 1 copay.  If a generic is not available for the condition you wish to treat, the use of a brand name medication designated as preferred (P) on our 2012 Commercial Formulary (1 824.83 kB)  is desired. These medications will have a Tier 2 copay. Any brand name not designated as preferred (P) is considered non-preferred and may result in the highest pharmacy copay for your patient.

Commercial Utilization Management Criteria

Capital Health Plan uses Utilization Management tools as needed to ensure that medications are used in a safe and cost effective manner. Commercial Criteria for those selected medications are available for download. If the medication is marked "specialty", it must be obtained through Caremark Specialty Pharmacy Services in order for it to be covered. The physician will need to obtain and complete a Caremark Specialty Enrollment Form (pdf 42.84 kB) for all new prescriptions. Upon completion, the enrollment form should be faxed to Caremark and the Capital Health Plan Pharmacy Services Department. Clinical criteria for Medicare members can be found on our Medicare website.

Safe Practices for Medications

Below are some websites to the Food and Drug Administration and the Institute for Safe Medication Practices that contain important information on patient safety:

• List of Error Prone Abbreviations, Symbols, and Dose Designations
• List of Confused Drug Names
• List of High Alert Medications
• Food and Drug Administration (FDA) Drug Recalls, Market Withdrawals, and Safety Alerts
• USP-ISMP Medication Error Reporting Program

Capital Health Plan Pharmacy Network

Capital Health Plan contracts with over 64,000 pharmacies nationwide. To locate a pharmacy in our network, use our pharmacy locator. Capital Health Plan members may also contact Caremark’s customer service department at 1-800-966-5772.