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. 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

On October 1, 2020, True Health New Mexico launched a medication therapy management (MTM) program. Members who are eligible for this no-cost clinical program will receive an introductory call from a pharmacist, who will offer the opportunity to complete a medication review. Additionally, the MTM team will conduct medication adherence outreach to certain True Health New Mexico members who qualify for the adherence program.

Most members find that MTM programs offer very valuable information. Examples of issues identified during a medication review include drug interactions, dosage issues, duplicated therapies, unnecessary medications, necessary medications not yet prescribed, etc. Members who prefer not to participate in the program may tell the caller they want to opt out.

Prior Authorization

The prior authorization (PA) process can be confusing. This document, Understanding the Prescription Drug PA Process, 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

Federal Employees

Large Employer Groups

$0 Member Cost-Share Prescription Drugs

Do You Have Asthma or Diabetes?

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

Pharmacy Resources for Providers

Find drug safety reports, opioid management program resources, and more on this page.

Programs and Other Information

Other Drug Lists
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. 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.
Opioid 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.

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.

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.

Examples of drugs covered under the True Health New Mexico medical and pharmacy benefits

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 most 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 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.