CVS Online Portal
Use this portal to:
View Your Prescription History
Check Medication Costs
Check Mail Order Status
Get the Most from Your Pharmacy Benefit
Prescription medications are integral to maintaining good health. Review our list of zero-dollar copay generic medications for chronic conditions and 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.
New Medication Therapy Management Program: What You Should Know
In late 2020, True Health New Mexico launched a medication therapy management (MTM) program. Members who are eligible for this no-cost clinical program will receive a phone call from a pharmacist. The pharmacist will offer the opportunity to complete a medication review. The MTM team also will conduct medication adherence outreach to certain members who qualify for the adherence program.
Most members find MTM programs useful and valuable. MTM programs can identify issues such as drug interactions, dosage issues, duplicated therapies, unnecessary medications, necessary medications not yet prescribed, etc. Members who prefer not to participate in the program can tell the caller they want to opt out.
The prior authorization (PA) process can be confusing. This document, Understanding How Prior Authorization Works with Your Prescription Drug Benefit, can help you make sense of PAs and what actions you and your doctor should take.
Formulary (List of Covered Drugs)
Note: Are you an Albuquerque Public Schools employee? Visit Express Scripts® for your pharmacy benefit information.
Individual / Family Plans & Small Groups
Large Employer Groups
$0 Member Cost-Share Prescription Drugs
Do You Have Asthma or Diabetes?
We have tips to help our members with asthma and diabetes lower their out-of-pocket expenses.
Pharmacy Resources for Providers
Providers can find drug safety reports, opioid management program resources, and more on this page.
Programs & Other Important Information
Other Drug Lists
- Changes to our individual and small-group formulary
- Changes to our large-group formulary
- Changes to our federal employees formulary
- Drugs that require prior authorization and step therapy for individual plan, small group, and federal employee members
- Drugs that require prior authorization and step therapy for large group plan members
- Definitions of prior authorization, quantity limits, and step therapy
- Formulary alternatives for individual and small group plan members
- Formulary alternatives for large group plan members
- Formulary alternatives for federal employee members
- Site-of-care program fact sheet
Insulin Copayment Cap Effective January 1, 2021
Effective January 1, 2021, a $25 insulin copay cap will be in place for our members. Existing members who are impacted by this change have been notified by mail.
This new program will apply a copay of no more than $25 per 30-day supply of preferred insulins on our formulary OR a medically necessary alternative (whether on the formulary or not). Medically necessary alternatives will be reviewed through the normal pharmacy prior authorization process. If approved, the alternative will process for a $25 copay per 30-day supply (or less, if the full cost of the product is less than $25).
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.
- Aralast NP
- Gammagard liquid
- Gammagard S/D
- Simponi Aria
- Stelara IV
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.
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
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.
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.
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).
Appropriate Use of Antibiotics: Information for Members
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.
- Antibiotic treatment in the hospital
- Antibiotics for people with catheters
- Colds, flu, and other respiratory illnesses in adults
- Antibiotics for your skin
- Oral antibiotics for ear infections
- Antibiotics for urinary tract infections in older people
- Antibiotics for pink eye
- Antibiotics for a sore throat, cough, or runny nose in children
- Treating sinus problems