Pharmacy Network & Over-the-Counter

NOTE: The Caremark Medicare Part D Network meets access requirements in all regions and in all states. In addition, Caremark has not received any deficiency notices from CMS regarding the Caremark Medicare Part D Network.

Filling Prescriptions Out-of-Network

Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Below are some situations where we would cover prescriptions filled at an out-of-network pharmacy. 

Requesting Reimbursement

You can ask us to reimburse you for our share of the cost by submitting a Prescription Reimbursement Form. However, even after we reimburse you for our share of the cost, you may pay more for a drug purchased at an out-of-network pharmacy because the out-of-network pharmacy's price is higher than what a network pharmacy would have charged.

You should submit a prescription reimbursement request to us if you:

• Fill a prescription at an out-of-network pharmacy (as any amount you pay, consistent with the situations listed above, will help you qualify for catastrophic coverage).

• Pay the full cost for a prescription because you don't have your plan membership card with you.

• Take self-administered medications that are not covered by Medicare Part B in an outpatient setting.

NOTE: Out-of-network prescriptions are limited to a 30-day supply.

Pharmacies with Preferred Cost-Sharing 

Martin's Point Generations Advantage is happy to offer a network of pharmacies with preferred cost sharing—including Hannaford Pharmacies, CVS Pharmacies and Martin's Point Health Care Center Pharmacies in Portland, ME and Portsmouth, NH.

In the network of pharmacies with preferred cost sharing, Generations Advantage members receive medications in all tiers of the Generations Advantage formulary (or drug list) at lower copays than at pharmacies with standard cost sharing.

View your plan's Part D Pharmacy Deductibles & Cost-Sharing here.

CVS Caremark Mail-Order Pharmacy Service

IMPORTANT NOTE: Please note that you must use the mail-order service operated by CVS Caremark. Prescription drugs that you get through any other mail-order service are not covered.

Automatic Refill Service

For refills of your drugs, you have the option to sign up for an automatic refill program called ReadyFill at Mail^®.

Under this program we will start to process your next refill automatically when our records show you should be close to running out of your drug. The pharmacy will contact you prior to shipping each refill to make sure you are in need of more medication, and you can cancel scheduled refills if you have enough of your medication or if your medication has changed. If you choose not to use our auto-refill program, please contact your pharmacy 15 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time.

So the pharmacy can reach you to confirm your order before shipping, please make sure to let the pharmacy know the best ways to contact you. Please contact CVS Mail Order Customer Care at 1-888-296-6961 for options regarding automatic refill preferences.

To opt out of our program that automatically prepares mail order refills, please contact CVS Customer Care at 1-888-296-6961. 

CVS Over-the-Counter Coverage

Members receive a quarterly amount to purchase from over 350 CVS-brand, over-the-counter products. Each quarter, you can make qualifying purchases in person at participating CVS retail locations, by phone, or online up to your plan's quarterly allowed amount.

Multiple transactions may be made throughout the quarter until the quarterly maximum amount is reached. Purchases may not exceed quarterly amounts. Unused benefit amounts do not carry over to the next quarter. All items must be for the member’s use only.

Eligible items include CVS-brand items:

• Smoking Cessation: Nicotine replacement patches, Nicotine Gum
• Oral Health: Toothpaste, toothbrushes, denture cleaning tabs, floss and floss picks
• Pain Relief: Ibuprofen, acetaminophen, heating pad, pain relieving cream/gel, lidocaine cream and patches
• Allergy: Allergy relief tablets, nasal spray
• Cold Remedies: Cough drops and sore throat spray, daytime/nighttime cold medicine, thermometer, cold and flu relief, nasal spray
• Digestive Health: Heartburn and stomach relief, stool softener, Omeprazole tablets, dairy relief, daily fiber
• First Aid: Bandages, ointment, masks, gauze
• Incontinence: Bladder control products
• Vitamins and Supplements: Women’s and Men’s Multivitamins, Vitamin D3, Omega-3, Iron Supplement, Melatonin, Calcium

The OTC benefit covers more than this partial list. Explore all available items in the OTC Catalog:

What is the quarterly amount I can use to make OTC purchases?

The quarterly amount for each Generations Advantage plan is as follows:

How often can I use my OTC benefit?

The "purchase year" begins in January. You can make multiple purchases throughout each quarter (three-month period) up to your quarterly maximum. Amounts do not roll over into the next quarter. Quarterly benefit periods are distributed as follows:

Three easy ways to place an order!

Members can order CVS over-the-counter products online, by phone, or in person at participating local CVS Pharmacies.

The fastest and easiest way to order 24/7 is to visit: MartinsPoint.org/OrderOTC.