CVS Specialty Pharmacy
Specialty medications treat specific medical conditions such as cancer, hemophilia, hepatitis, multiple sclerosis, psoriasis, pulmonary arterial hypertension, respiratory syncytial virus, rheumatoid arthritis, and more. You can fill these prescriptions through CVS Specialty Pharmacy. CVS Specialty Pharmacy is a pharmacy that provides specialty medications. Please call 1-800-237-2767 between the hours of 6:30 a.m. to 8 p.m. (CT) Monday through Friday to learn more about filling your specialty medication.
Download CVS Specialty Pharmacy's "Five Things You Should Know about Our Specialty Pharmacy" brochure.
Pharmacy Forms and Notices for Members
You can find the Drug Prior Authorization Request Form on our
Forms and Other Resources for Members page.
Important Pharmacy Terms
For you to understand your pharmacy benefits and get the most out of your coverage, we suggest that you read the definitions for three important pharmacy terms: generic substitution, therapeutic interchange, and step therapy.
Generic drugs: A chemically and pharmaceutically equivalent (equal) version of a brand-name drug whose patent has expired. A generic drug meets the same FDA standard for bio-equivalency that brand-name drugs must meet. However, a generic drug is usually less costly. Your pharmacist will substitute a generic drug for you automatically when one is available, even if your provider writes a prescription for the brand drug. If the generic drug does not meet your needs, your provider can start a pharmacy exception. You may then receive the brand drug, depending on the drug’s clinical criteria and if True Health New Mexico Pharmacy Services approves the exception.
Therapeutic interchange: The practice of substituting one drug for another (a therapeutic alternative) when both drugs work the same way and have the same therapeutic effects (benefits). This substituted drug is called the therapeutic alternative. When you get your prescription filled, your pharmacist will tell you if a therapeutic alternative has been made for you. The pharmacist can do this only with your provider’s approval.
Step Therapy: Step therapy is the practice of treating a patient first with the least costly drug. If that drug does not work for the patient, the provider will prescribe higher-cost drugs or therapies, if medically necessary. Step therapy applies only to certain drugs. True Health New Mexico has criteria for step therapy that helps to decrease the practice of prescribing the most-costly drug when a less costly drug may work just as well. CVS Caremark, the administrator for True Health New Mexico Pharmacy Services, will need information from your provider if there is a medical reason that you can't complete all of the "steps" in the process before moving to the more costly drug.
Pharmacy Notices for Providers
Criteria sets: Providers contracted with True Health New Mexico may request copies of the True Health New Mexico criteria sets from True Health New Mexico Pharmacy Services by calling 1-866-823-1606.
Drug Safety Reports
Download a PDF of our drug safety report for the first quarter of 2018.
Drugs Covered under Medical vs. Pharmacy Benefit
Some medications are covered under the True Health New Mexico medical benefit, while others are covered under the True Health New Mexico pharmacy benefit. Member cost-share may be different based on which benefit is used. While not all-inclusive, this comparative list will help educate you about the differences between the two classifications.