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Pharmacy/Formulary

CVS Online Portal

Use this portal to:

View Your Prescription History

Refill Prescriptions

Check Medication Costs

Check Mail Order Status

Get the Most from Your Pharmacy Benefit

Prescription medications are integral to maintaining good health. On this page, you can view our formularies (lists of covered medications) and lists of zero-dollar copay generic medications for chronic conditions. You can also compare your coverage options for non-preferred, preferred (brand-name), generic, and specialty medications to get the most out of your plan coverage.

Do You Have Questions about Your Pharmacy Benefits?

We have answers. Please read our Pharmacy FAQ.

Understanding the Prior Authorization (PA) Process

Prior authorization can be confusing. This one-page overview can help you understand the steps your provider and True Health New Mexico need to take when your prescription drug requires prior authorization.

Formulary (List of Covered Drugs)

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

New! Online Formulary Search Tool

To use our formulary search tool, click on the link below that corresponds to the type of plan you have. Type the name of the medication into the search box and click Search. The search results screen will display the medication’s copayment tier and whether there are any restrictions on its use.

Formulary Search Tool for Individual / Family & Small Group Plans

Formulary Search Tool for Large Employer Group Plans

Additional Drug Lists & Drug Information

2022 Drug List PDFs to Download or Print

We now offer an easy-to-use formulary search tool, available at the links above. But if you would rather use our PDF formularies, which you can download and print, select one of the links below.

Individual/Family and Small Group Plans Formulary – PDF

Large Group Plans Formulary – PDF

Large Group Formulary Changes
Other Drug Lists
$0 Member Cost-Share Prescription Drugs
$0 Copay for Certain Behavioral/Mental Health Medications

Most of our plans offer a $0 copay* for inpatient and outpatient behavioral and mental health services, including certain medications from participating pharmacies.

The list of $0 copay behavioral health drugs can be found in the preface of each formulary (under $0 Behavioral Health Drug List).

*The $0 copay for behavioral/mental health services does not apply to our HDHP plans.

For Members with Asthma or Diabetes

We have tips to help our members with asthma and diabetes lower their out-of-pocket expenses.

Important Infusion Therapy Information
  • Outpatient infusions for maintenance medications may be administered in several different settings:  in a hospital-based infusion clinic, at a provider office, at an ambulatory infusion suite, or at home.
  • In many cases, outpatient infusions are less expensive for members in a provider office, at an ambulatory infusion suite, or, when feasible, at home.
  • For certain infused medications, True Health New Mexico requires that members use our designated infusion partner, Optum Infusion Services. You can reach Optum Infusion Services at (505) 830-1800.
  • In this Site-of-Care program, members move from the outpatient hospital infusion setting to a lower-cost and generally more convenient setting. The most appropriate site of care will vary depending upon the particular drug involved.
  • True Health New Mexico is currently contracted for infusion services with Optum Infusion Services and HME Specialists, as well as a few other providers. Members can contact Customer Service for more details about contracted infusion providers.
  • Below is the list of drugs currently included in the Site-of-Care Program and that must be provided by Optum Infusion Services. These infused drugs also require prior authorization for use.
ACTEMRA ADAKVEO ADUHELM
ALDURAZYME ARALAST NP ASCENIV
AVSOLA BENLYSTA BERINERT
BIVIGAM CEREZYME CIMZIA
CINQAIR CYTOGAM ELAPRASE
ELELYSO ENTYVIO FABRAZYME
FLEBOGAMMA DIF GAMMAGARD S/D GAMMAKED
GAMMAPLEX GAMMUNEX-C GLASSIA
HYQVIA INFLECTRA INFLIXIMAB
KRYSTEXXA LEMTRADA LUMIZYME
NEXVIAZYME NULOJIX OCREVUS
OCTAGAM ORENCIA PANZYGA
PRIVIGEN RADICAVA RECLAST
REMICADE RENFLEXIS RIABNI
RITUXAN RITUXAN HYCELA RUXIENCE
SIMPONI ARIA SOLIRIS STELARA
TRUXIMA TYSABRI ULTOMIRIS
VPRIV VYVGART ZEMAIRA
ZOLEDRONIC ACID
Outpatient Prescription Drugs

Your prescription drug benefits are provided by True Health New Mexico Pharmacy Services, administered by CVS Caremark. You can contact CVS Caremark at 1-866-341-8561. True Health New Mexico requires you to use a pharmacy in the CVS Caremark network or CVS Caremark mail-order program. The CVS network includes major national and regional retail pharmacies, as well as local and independent pharmacies, throughout New Mexico and the U.S., and a specialty pharmacy called CVS Specialty Pharmacy.

True Health New Mexico provides coverage for drugs, supplies, supplements, and administration of a drug (if such services would not otherwise be excluded from coverage). The drugs must be prescribed by a licensed and qualified provider. True Health New Mexico offers a $0 copay for many generic drugs for chronic conditions such as asthma, diabetes, and depression, on most plans.

True Health New Mexico uses a preferred drug list (formulary). This is a list of prescription drugs that we cover. The formulary includes drugs for a variety of diseases and conditions. If you have questions about our formulary or your outpatient prescription drug benefits, call Customer Service at 1-844-508-4677. You’ll find more information about prescription drug limitations and exclusions in the Exclusions section of your Evidence of Coverage (Member Handbook).

Programs, Information, & Resources

Copay Card Accumulator Program

Some specialty medications may qualify for third-party copayment assistance programs that could lower your out-of-pocket costs for those products.

For any such specialty medication for which third-party copayment assistance is used, the member shall not receive credit toward the plan’s deductible or out-of-pocket maximum for any copayment or coinsurance amounts that are applied to a manufacturer coupon or rebate.

If a covered prescription drug was paid for by using a drug manufacturer’s coupon or copay card, this amount will not apply to the member’s plan deductible or out-of-pocket limit.

Search our Copay Card Accumulator Drug List here.

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 included in the split-fill program.

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.

Pharmacy Resources for Providers

Providers can find drug safety reports, opioid management program resources, and more on our Provider Pharmacy Resources page.