Pharmacy / Formulary

Note: Are you an Albuquerque Public Schools employee? Visit Express Scripts® for your pharmacy benefit information. 

CVS Caremark

CVS Opens Nine New COVID-19 Drive-Through Test Sites in New Mexico

True Health New Mexico Pharmacy Services provides clinical services for True Health New Mexico members, including the review of pharmacy prior authorization requests. True Health New Mexico partners with CVS Caremark™ for prescription claims processing and the pharmacy network.

CVS Caremark and True Health New Mexico Pharmacy Services work together to design and manage your pharmacy benefit plan. This includes creating your list of covered medications (also called a formulary), determining how much you will pay for your medication, and providing you with programs and services to help you effectively manage your health.

To learn more about your prescription drug benefits, register at Caremark.com or download the CVS Caremark mobile app to:

  • Review your coverage and annual spending
  • Find opportunities to save
  • See your prescription history
  • Check medication costs using the CVS Caremark Check Drug Cost tool
  • Find in-network pharmacies using the CVS Pharmacy Locator tool (works best in Chrome)
  • Refill prescriptions
  • Check your mail-order status

Learn more at Caremark.com/video.

30-Day Mail-Order Now Available for Individual and Family Plan Members

If you are enrolled in a True Health New Mexico individual or family plan, you now have access to 30-day supplies of medication at CVS Mail Service. Scroll down and select the mail-order form from Pharmacy Forms and Notices for Members below. Download the form and fill it out according to the instructions. (Members of our small and large group plans may order up to a 90-day supply.)

Prior Authorization for Prescription Drugs: What You Should Know
The prior authorization (PA) process can be confusing. This document can help you make sense of PAs and what actions you and your doctor should take.
Important Pharmacy Terms and Their Definitions
To get the most out of your pharmacy benefits, we suggest you read the definitions for some important pharmacy terms.
Important Notices for Asthma and Diabetes Patients
Do you have asthma or diabetes? Please read and download this information about the asthma and diabetes medications and supplies covered on our formulary. Using products on this list can help lower your out-of-pocket expenses. Talk to your provider about these products.
Appropriate Use of Antibiotics
To help educate you about appropriate antibiotic use and to help you talk to your doctor about antibiotics, we’re offering links to Choosing Wisely’s patient education resources. They will help you learn when you should and should not take antibiotics.

Pharmacy Programs for Members

True Health New Mexico and CVS Caremark has implemented pharmacy programs to help improve your safety, keep you on the medications you need to manage your chronic condition(s), and reduce your out-of-pocket costs.

  • Opioid Program: This program addresses opioid overuse, which, according to the Centers for Disease Control and Prevention (CDC), is an epidemic in the U.S. You may notice restrictions on the strengths or quantities of high-potency opioid pain medications that can be dispensed at the pharmacy. Get the facts about opioid abuse and misuse on the CDC website.
    • Do you need help locating an opioid treatment (buprenorphine) prescriber? Click here to locate a provider. Note: Please call Customer Service at 1-844-508-4677 to confirm that the provider you have selected is in the True Health New Mexico network.
  • Medication Split-Fill Program: True Health New Mexico partners with CVS Caremark on a program that limits initial fills of certain high-risk medications and oncology medications to two 15-day supplies. After the first two 15-day supplies are used, the full prescribed quantity will be covered at one time. This program will work to ensure that members can tolerate these medications and may reduce potential waste. Download the list of drugs that are included in the split-fill program.
  • Medication Adherence Program: In this program, you may receive reminders when you are late to refill medications for chronic conditions. Taking prescribed medications on a regular basis leads to better outcomes in chronic conditions.
  • Copay Card Accumulator Program: This program will ensure the integrity of the pharmacy benefit and will accurately capture your out-of-pocket cost when you use a manufacturer-issued copay coupon/card.

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. Please call 1-800-237-2767 between the hours of 5:30 a.m. to 7:00 p.m. (MST) 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 Notices for Providers

Drugs covered under medical vs. pharmacy benefit
Some medications are covered under our medical benefit, while others are covered under our 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.
CVS/Caremark Opioid Management program
True Health New Mexico members are subject to the CVS/Caremark Opioid Management program. This program limits the dose/quantity of opioids that members can receive. If a member exceeds the limitations, prior authorization is required. In general, prior authorization can be satisfied by providing a copy of the member’s current treatment plan, a risk assessment evaluation, and a copy of the member’s opioid contract. Prescribers may also attest to use of these specific tools. Prescribers should fax prior authorization requests for opioids to True Health New Mexico Pharmacy Services at 1-866-718-7938. Below are several resources to help True Health New Mexico providers manage their patients who are taking opioids. True Health New Mexico providers are not required to use these resources; they are offered as a convenience.