Announcing our new partner, CVS Caremark

Here’s what you need to know about our new pharmacy benefit manager.

Oct. 22, 2019 — We are excited to announce our partnership with CVS Caremark®, the prescription benefit management subsidiary of national health care leader CVS Health®. Effective Jan. 1, 2020, CVS Caremark will be our new pharmacy benefit manager (PBM). This transition will help keep our rates competitive, and enable us to continue offering the highest quality health care to our members. It will also bring some new customer enhancements, including:

  • Dedicated prescription helplines staffed by experts who are available to answer all customer, provider and pharmacist questions 24/7.
  • An improved digital pharmacy experience that allows customers to access pharmacy benefit, network and cost information through our website and Sharp Connect.
  • Enhanced digital tools, like the free CVS Caremark mobile app that lets members see their personalized pharmacy benefit information, refill or request new mail service prescriptions, track order status, view prescription history and much more.

While we have made every effort to mitigate potential disruptions, there will be some updates to our pharmacy network and formulary in 2020:

  • Our pharmacy network (where prescriptions can be filled) will remain 99% the same. Members can continue using all Sharp® pharmacies, in-network community pharmacies, and retail pharmacy chains such as Albertsons®, Costco  ®, Ralphs®, Rite Aid®, Vons®, Walgreens® and Walmart® in addition to CVS Pharmacy®.
  • We will be updating our formulary (also known as a drug list) for 2020. There will be more positive changes to the formulary than negative. We will cover non-formulary drugs only when their use has been determined to be medically necessary after a review of a member’s specific needs. There will also be some tier, specialty drug and utilization management updates, including new step therapy, prior authorization and quantity limit requirements. Go to to see the 2020 formulary.

To help ensure this is a seamless transition for you and your clients, we will:

  • Honor existing pharmacy prior authorizations until the date noted on your clients’ original approval letter from Sharp Health Plan.
  • Give your clients who are enrolled in benefits on our Tier 3 formulary a 31-day grace period on their current medications if they are impacted negatively by the 2020 formulary changes. These clients will have until Feb. 1, 2020 before the negative changes go into effect. All other changes will still be effective Jan. 1, 2020.

Here’s what we’ll be communicating to your employer clients, and when:

  • This week, we will notify employers about these changes through a mailed letter. Per their Group Service Agreement with Sharp Health Plan, they are responsible for notifying their employees about the 2020 formulary changes. We will ask them to communicate these changes by the end of October as impacted members will receive our initial outreach as early as November. To assist them, we will provide resources, including an email template and FAQ.
  • In November and December, we will send employers email updates about the PBM transition. These emails will be timed before sending any of our member-facing communications, and will serve as reminders of our planned outreach to their employees.

Here’s what we’ll be communicating to your member clients, and when:

  • In November and December, we will notify members about any potential impact. These notices will only be mailed to members who are taking drugs that will be affected by changes to the formulary. Members will be directed to work with their doctors if they have questions. Doctors will be notified of these changes so that they are prepared to assist members with questions.
  • In December, we will also issue new member ID cards to all members. These cards will include new PCN and BIN information, which is used by pharmacies when members fill a prescription. Beginning Jan. 1, 2020, members must use their new cards when getting care and filling prescriptions.

We will send you email updates in the coming months. These will be timed before sending any of our employer or member-facing communications, and will serve as reminders of our planned outreach outlined above. If you have questions related to this new partnership, please read our FAQ, or contact your account management executive.