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Prescriptions

Prescription Coverage

 

 

Clovis Unified School District is contracted with CVS Health, Inc. for prescription coverage with many pharmacies to choose from in the Clovis/Fresno area as well as across the United States.

The CUSD prescription plan covers a range of medications from generic to specialty. Copays & formularies are listed below with further details.

Member Cost Share

30 Day Supply Copays

See our Advanced Control Formulary below for a list of covered medications.

$9

Generic

$30

Preferred Brand

$40

Brand Name

90-100 Day Supply Copays

See our Advanced Control Formulary below for a list of covered medications.

$18

Generic

$60

Preferred Brand

$80

Brand Name

Specialty Prescription Copay

CUSD has partnered with PrudentRx through CVS Caremark to provide specialty medications at no cost to covered employees & dependents. In order to fill specialty prescriptions not otherwise covered by the Advanced Control Formulary, members must sign up for the PrudentRx program (at no additional cost).

See our PrudentRx Specialty Medication Formulary for a list of covered specialty medications under the PrudentRx program.

To enroll, please call PrudentRx toll-free at 1-800-578-4403 Monday through Friday, 8AM to 5PM ET.

$0

For both 30 day & 90-100 day supplies. Enrollment with PrudentRx required to participate.

Access the Prudent Rx Specialty Formulary

Advanced Control Formulary

An Advanced Control Formulary is a list managed by CVS Caremark that details medications covered under the Health Plan and provides alternatives to medications that are not covered.

 

CVS Caremark updates & releases a new formulary every quarter during the months of January, April, July, and October.

 

See below for the most recently-released formulary:

 

Preview unavailable.
Click here to view Advanced Control Formulary - Effective 1/2025.

  • When CVS excludes a medication from the formulary, at least two alternatives are provided. In certain instances, a patient may be unable to tolerate those alternatives. Their doctor can request a pre-authorization to utilize the non-formulary medication. Requests for pre-authorizations must include documentation of the patient attempting to use the alternatives & having an inadequate treatment response and/or intolerance to the required number of formulary alternatives.

    To get a pre-authorization for a non-formulary medication, have your doctor utilize the numbers below.

    Please note: these are physician-only numbers & cannot be utilized by patients.

    CVS Pre-authorization Physician-Only Number: 866-443-1183

    CVS Pre-authorization Phyisican-Only Fax: 866-689-3092

Maintenance Choice Medication & Mail Order Program

For those that prefer a local option to fill prescriptions, the Maintenance Choice Program allows members to fill certain 84+ day supplies of maintenance medications at select participating pharmacies, now including Costco. Click the link above for a list of in-network pharmacies for participating locations**.

  • Employees & their covered dependents who routinely take maintenance medication can utilize the Mail Order Program to obtain their 84+ day prescriptions for the price of a 60-day supply (see co-payment fee schedule above).
  • Mail Order prescriptions can be filled by completing the Mail Order Prescription Claim Form & mailing it with your prescription(s) to the Mail Order Program in San Antonio, Texas.

For more information regarding the Mail Order Program, contact CVS Health at 800.966.5772.

**Please note that provisions or exclusions may apply in Florida, Minnesota, Oklahoma, Tennessee, and West Virginia.

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