Pharmacy
Your pharmacy benefits will be provided through OptumRX until December 31, 2025. Starting January 1, 2026, they will be managed by CVS Caremark.
Know your drug coverage
We designed this Pharmacy Benefits Member Guide to help you easily understand your coverage and make the most of it. Inside, you'll also find smart ways to save on prescription costs. Because plans can vary, be sure to check your Evidence of Coverage for specific coverage details.
Pharmacy benefits are covered through a CalPERS direct contract with OptumRx. After you enroll, you will receive an ID card from Health Net which will include your medical benefits and OptumRx info.
For complete pharmacy listings and details on what's covered, call OptumRx at 855-505-8110 or visit the OptumRX web page.
| Pharmacy | Generic | Brand formulary | Non-formulary |
|---|---|---|---|
| Retail pharmacy | $5 | $20 | $50 |
| Mail order pharmacy | $10 | $40 | $100 |
| Pharmacy | Tier 1 | Tier 2 | Tier 3 |
|---|---|---|---|
| Retail Pharmacy (up to a 30-day supply) | $5 | $20 | $50 |
| Retail Pharmacy (up to a 90-day supply of maintenance medication) | $10 | $40 | $100 ($70 copyament with an approved Partial Copay Waiver) |
| CVS Caremark® Mail Service Pharmacy (up to a 90-day supply of maintenance medication) | $10 | $40 | $100 ($70 copyament with an approved Partial Copay Waiver) |
| Specialty Pharmacy (up to a 30-day supply) | $5 | $20 | $50 |
Note: Effective January 1, 2026, your pharmacy benefits will be covered through a CalPERS direct contract with CVS Caremark. For complete pharmacy listing and coverage details, call CVS Caremark at 833-291-3649 or visit CVS Caremark Pharmacy Benefits for CalPERS.
Note: the CVS Caremark phone number and web address will not be available until September 15, 2025.
Drug Lists
Cost Savings Tip: Ask for generic alternatives to brand-name medications