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USAble Mutual Insurance Company

Pharmacy Benefits

If Caremark is the pharmacy benefits administrator listed on your ID card and you need more information regarding your pharmacy coverage, call 1-888-293-3748.

Your prescriptions claims history — including prescription number, date filled, prescriber, quantity, pharmacy, amount paid by you and amount paid by your pharmacy plan — can be found within My Tracker, our member self-service center.

Pharmacy Links

Network Pharmacy Search
Search for a network pharmacy by name, city, state or zip code. Maps and driving directions are provided.

Specialty Drugs
A description of the program that covers injectable and select oral medications.

Mail-Order Drugs
A description of the mail-order option some employers have chosen for their employees and a link to the mail-order form.

Using Your Pharmacy Benefits
How to use your benefits and the advantages your pharmacy plan offers you.

What is Step Therapy? [pdf, 687 KB]

Forms

Language Assistance Available [pdf, 778 KB]

Prescription Claim Form [pdf, 1721 KB]
Printable form in portable document format (PDF).

Texas Prior Authorization Form [pdf, 240 KB]
Please submit completed form to our secure fax line 501-378-6980. For further questions please contact us at 1-888-293-3748

Prior Approval Form for Prescription Drugs [pdf, 938 KB]

This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed forms to CVS/Caremark at 1-855-245-2134 for prior approval and quantity limit requests. Please contact CVS/Caremark at 1-855-582-2022 with questions regarding the prior approval and quantity limit review process. For Step Therapy and Non-Formulary Exception requests, fax the form to 501-378-6980. For Step Therapy and Non-Formulary Exception request questions, contact 501-378-3392.

Drug Lists

Note: Your plan's covered drug list may vary from this standard formulary. Call the Customer Service number on your ID card or consult your group administrator to verify this formulary.

Metallic Formulary [pdf, 5490 KB]

Standard with Step Drug List [pdf, 1508 KB]

Standard with Step Therapy Formulary [pdf, 2828 KB]

Standard/Standard with Step Prior Approval List [pdf, 677 KB]
Medications that require prior approval. For authorization, call 855-582-2022.