Pharmacy benefits

We also cover some over-the-counter (OTC) products (PDF)  at no cost when you: 

• Meet any added requirements (for some medicines) 
• Get a prescription from your provider 
• Fill your OTC prescription at a network pharmacy (Walgreens isn’t in our network)

Still not sure if we cover your medicine? Just call ${MS_phone_1} or ${MS_phone_2} (TTY 711). When you call, have a list of your OTC medicines ready. We can check them for you. 

CVS Specialty® fills your specialty medicine. They also have other special services for you:

• Access to a pharmacist 24 hours a day, 7 days a week
• Counseling about your drug and disease
• Coordination of care with you and your doctor
• Delivery of specialty medicine to your home or doctor’s office at no cost 
• Use of any CVS Pharmacy® (including those inside Target stores) for prescription drop-off and medicine pickup

Call CVS Specialty at 1-800-237-2767 (TTY 1-800-863-5488) for help. You can also check the specialty drug list (PDF) to see your options.

November 2023

Additions: None

Removals

• Proctofoam HC 1% to 1% rectal foam

 Other updates

• Haloperidol 0.5 mg tablet (age limit updated)

• Haloperidol 1 mg tablet (age limit updated)

• Haloperidol 10 mg tablet (age limit updated)

• Haloperidol 2 mg tablet (age limit updated)

• Haloperidol 20 mg tablet (age limit updated)

• Haloperidol 5 mg tablet (age limit updated)

• Haloperidol lactate 2 mg per mL oral concentrate (age limit updated)

• Haloperidol lactate 5 mg per mL solution injection (age limit updated)

• Loxapine succinate 10 mg capsule (age limit updated)

• Loxapine succinate 25 mg capsule (age limit updated)

• Loxapine succinate 5 mg capsule (age limit updated)

• Loxapine succinate 50 mg capsule (age limit updated)

• Nayzilam 5mg per 0.1 mL nasal spray (quantity limit updated, age limit added)

• Perphenazine 16 mg tablet (age limit updated)

• Perphenazine 2 mg tablet (age limit updated)

• Perphenazine 4 mg tablet (age limit updated)

• Perphenazine 8 mg tablet (age limit updated)

• Pimozide 1 mg tablet (age limit updated)

• Pimozide 2 mg tablet (age limit updated)

• Thioridazine HCl 10 mg tablet (age limit updated)

• Thioridazine HCl 100 mg tablet (age limit updated)

• Thioridazine HCl 25 mg tablet (age limit updated)

• Thioridazine HCl 50 mg tablet (age limit updated)

• Thiothixene 1 mg capsule (age limit updated)

• Thiothixene 10 mg capsule (age limit updated)

• Thiothixene 2 mg capsule (age limit updated)

• Thiothixene 5 mg capsule (age limit updated)

• Trifluoperazine HCl 1 mg tablet (age limit updated)

• Trifluoperazine HCl 10 mg tablet (age limit updated)

• Trifluoperazine HCl 2 mg tablet (age limit updated)

• Trifluoperazine HCl 5 mg tablet (age limit updated)

• Valtoco 10 mg nasal spray (quantity limit updated, age limit added)

• Valtoco 15 mg nasal spray (quantity limit updated, age limit added)

• Valtoco 20 mg nasal spray (quantity limit updated, age limit added)

• Valtoco 5 mg nasal spray (quantity limit updated, age limit added)

October 2023

Additions

• Dexmethylphenidate extended release 10 mg capsule (quantity limit, age limit)

• Dexmethylphenidate extended release 15 mg capsule (quantity limit, age limit)

• Dexmethylphenidate extended release 20 mg capsule (quantity limit, age limit)

• Dexmethylphenidate extended release 25 mg capsule (quantity limit, age limit)

• Dexmethylphenidate extended release 30 mg capsule (quantity limit, age limit)

• Dexmethylphenidate extended release 35 mg capsule (quantity limit, age limit)

• Dexmethylphenidate extended release 40 mg capsule (quantity limit, age limit)

• Dexmethylphenidate extended release 5 mg capsule (quantity limit, age limit)

• Gvoke Kit 1 mg per 0.2 mL solution (quantity limit)

• Gvoke prefilled syringe 0.5 mg per 0.1 mL solution (quantity limit)

• Gvoke prefilled syringe 1 mg per 0.2 mL solution (quantity limit)

• Infliximab 100 mg intravenous solution (prior authorization)

• Lintera 10% wash

• Naloxone 4 mg per 0.1 mL nasal liquid (OTC)

• Octagam 25 gm per 500 mL (5%) intravenous solution (prior authorization)

• Spiriva Respimat 1.25 mcg per inhalation solution

• Spiriva Respimat 2.5 mcg per inhalation solution

• Zegalogue auto-injector 0.6 mg per 0.6 mL solution (quantity limit)

Removals

• Aimovig auto-injector 140 mg per mL solution

• Aimovig auto-injector 70 mg per mL solution

• Avsola 100 mg reconstituted solution

• Ergotamine tartrate 2 mg and caffeine 100 mg suppository

• Focalin XR 10 mg capsule

• Focalin XR 15 mg capsule

• Focalin XR 20 mg capsule

• Focalin XR 25 mg capsule

• Focalin XR 30 mg capsule

• Focalin XR 35 mg capsule

• Focalin XR 40 mg capsule

• Focalin XR 5 mg capsule

• Makena 250 mg per mL oil

• Makena auto-injector 275 mg per 1.1 mL solution

• Pradaxa 100 mg packet

• Pradaxa 150 mg packet

• Pradaxa 20 mg packet

• Pradaxa 30 mg packet

• Pradaxa 40 mg packet

• Pradaxa 50 mg packet

Other updates

• Levocarnitine 330 mg tablet (prior authorization removed)

September 2023

Additions: None

Removals: None

Other updates: None

August 2023

Additions

• Tranexamic acid 650 mg tablet (prior authorization)

Removals

• Imbruvica 140 mg tablet (prior authorization)

• Tranexamic acid 650 mg tablet (prior authorization)

• Vogelxo 50 mg per 5 gram gel packet (prior authorization)

Other updates: None

July 2023

Additions

• Gefitinib 250 mg tablet (prior authorization)

• Kalydeco 13.4 mg packet (prior authorization)

• Lurasidone 120 mg tablet (quantity limit, age limit)

• Lurasidone 20 mg tablet (quantity limit, age limit)

• Lurasidone 40 mg tablet (quantity limit, age limit)

• Lurasidone 60 mg tablet (quantity limit, age limit)

• Lurasidone 80 mg tablet (quantity limit, age limit)

• Mekinist 0.05 mg per mL solution (prior authorization)

• Tafinlar 10 mg tablet (prior authorization)

• Trikafta 100 mg/50 mg/75 mg/75 mg therapy pack (prior authorization)

• Trikafta 80 mg/40 mg/60 mg/59.5 mg therapy pack (prior authorization)

Removals

• Esomeprazole magnesium delayed release 40 mg capsule

• Iressa 250 mg tablet

• Latuda 120 mg tablet

• Latuda 20 mg tablet

• Latuda 40 mg tablet

• Latuda 60 mg tablet

• Latuda 80 mg tablet

• Omega-3 ethyl esters 1 gm capsule

• Sucraid 8500 unit per mL solution

Other updates: None

June 2023

Additions

• First-metronidazole 50 mg/mL suspension (age limit)

• Tinidazole 250 mg tablet

• Tinidazole 500 mg tablet

• Vancomycin 25 mg per mL oral solution

• Vancomycin 50 mg per mL oral solution

Removals

• Firvanq 25 mg per mL oral solution

• Firvanq 50 mg per mL oral solution

• Repatha prefilled syringe 140 mg per mL solution

• Repatha Pushtronex cartridge 420 mg per 3.5 mL solution

• Repatha SureClick auto-injector 140 mg per mL solution

 Other updates: None

May 2023

Additions

• Gilenya 0.25 mg capsule (prior authorization, quantity limit)

• Trikafta 100 mg/50 mg/75 mg/150 mg tablet (prior authorization)

• Trikafta 50 mg/25 mg/37.5 mg/75 mg tablet (prior authorization)

Removals

• Capsaicin 0.1% cream

• Lidocaine 4% cream

• Triamcinolone acetonide powder

Other updates

• Fexofenadine 30 mg per 5 mL (changed quantity limit)

• Fingolimod 0.5 mg capsule (added quantity limit)

• Freestyle Libre 14 Day Sensor (changed quantity limit)

• Freestyle Libre 2 Sensor (changed quantity limit)

• Freestyle Libre 3 Sensor (changed quantity limit)

April 2023

Additions

• Ambrisentan 10 mg tablet (prior authorization)

• Ambrisentan 5 mg tablet (prior authorization)

• Aranesp 10 mcg per 0.4 mL prefilled syringe solution (prior authorization)

• Aranesp 100 mcg per 0.5 mL prefilled syringe solution (prior authorization)

• Aranesp 150 mcg per 0.3 mL prefilled syringe solution (prior authorization)

• Aranesp 200 mcg per 0.4 mL prefilled syringe solution (prior authorization)

• Aranesp 25 mcg per 0.42 mL prefilled syringe solution (prior authorization)

• Aranesp 300 mcg per 0.6 mL prefilled syringe solution (prior authorization)

• Aranesp 40 mcg per 0.4 mL prefilled syringe solution (prior authorization)

• Aranesp 500 mcg per 1 mL prefilled syringe solution (prior authorization)

• Aranesp 60 mcg per 0.3 mL prefilled syringe solution (prior authorization)

• Armour Thyroid 120 mg tablet

• Armour Thyroid 15 mg tablet

• Armour Thyroid 30 mg tablet

• Armour Thyroid 60 mg tablet

• Armour Thyroid 90 mg tablet

• Bivigam 5 gm per 50 mL intravenous solution (prior authorization)

• Bosentan 125 mg tablet (prior authorization)

• Bosentan 62.5 mg tablet (prior authorization)

• Fylnetra 6 mg per 0.6 mL prefilled syringe (prior authorization)

• Nivestym 300 mcg per mL solution (prior authorization)

• Nivestym 480 mcg per 1.6 mL solution (prior authorization)

• Octagam 1 gm per 200 mL (5%) intravenous solution (prior authorization)

• Octagam 10 gm per 100 mL (10%) intravenous solution (prior authorization)

• Octagam 10 gm per 200 mL (5%) intravenous solution (prior authorization)

• Octagam 2 gm per 20 mL (10%) intravenous solution (prior authorization)

• Octagam 20 gm per 200 mL (10%) intravenous solution (prior authorization)

• Octagam 30 gm per 300 mL (10%) intravenous solution (prior authorization)

• Octagam 5 gm per 100 mL (5%) intravenous solution (prior authorization)

• Octagam 5 gm per 50 mL (10%) intravenous solution (prior authorization)

• Pradaxa 110 mg pellet packet (quantity limit)

• Pradaxa 150 mg pellet packet (quantity limit)

• Pradaxa 20 mg pellet packet (quantity limit)

• Pradaxa 30 mg pellet packet (quantity limit)

• Pradaxa 40 mg pellet packet (quantity limit)

• Pradaxa 50 mg pellet packet (quantity limit)

• Testosterone 50 mg per 5 gm (1%) gel (prior authorization) (limited to one NDC)

• Xembify 1 gm per 5 mL (20%) solution vial (prior authorization)

• Xembify 10 gm per 50 mL (20%) solution vial (prior authorization)

• Xembify 2 gm per 10 mL (20%) solution vial (prior authorization)

• Xembify 4 gm per 20 mL (20%) solution vial (prior authorization)

• Ziextenzo 6 mg per 0.6 mL prefilled syringe (prior authorization)

• Zovirax 5% ointment (quantity limit)

Removals

• Acyclovir 5% ointment

• Aubagio 14 mg tablet

• Aubagio 7 mg tablet

• Fulphila 6 mg per 0.6 mL prefilled syringe

• Imbruvica 140 mg capsule

• Imbruvica 140 mg tablet

• Imbruvica 280 mg tablet

• Imbruvica 420 mg tablet

• Imbruvica 560 mg tablet

• Imbruvica 70 mg capsule

• Imbruvica 70 mg per mL suspension

• Jakafi 10 mg tablet

• Jakafi 15 mg tablet

• Jakafi 20 mg tablet

• Jakafi 25 mg tablet

• Jakafi 5 mg tablet

• Lenalidomide 10 mg capsule

• Lenalidomide 15 mg capsule

• Lenalidomide 20 mg capsule

• Lenalidomide 25 mg capsule

• Lenalidomide 5 mg capsule

• Letairis 10 mg tablet

• Letairis 5 mg tablet

• Leukeran 2 mg tablet

• Myleran 2 mg tablet

• Neupogen 300 mcg per 0.5 mL prefilled syringe

• Neupogen 300 mcg per 0.5 mL vial

• Neupogen 480 mcg per 0.8 mL prefilled syringe

• Neupogen 480 mcg per 1.6 mL vial

• Nyvepria 6 mg per 0.6 mL prefilled syringe

• Provida OB 20 mg/20 mg/1.5 mg capsule

• Revlimid 10 mg capsule

• Revlimid 15 mg capsule

• Revlimid 2.5 mg capsule

• Revlimid 20 mg capsule

• Revlimid 25 mg capsule

• Revlimid 5 mg capsule

• Rydapt 25 mg capsule

• Salicylic acid 6% cream

• Salicylic acid 6% shampoo

• Sprycel 100 mg tablet

• Sprycel 140 mg tablet

• Sprycel 20 mg tablet

• Sprycel 50 mg tablet

• Sprycel 70 mg tablet

• Sprycel 80 mg tablet

• Tabloid 40 mg tablet

• Tamiflu 30 mg capsule

• Tamiflu 45 mg capsule

• Tamiflu 6 mg per mL suspension

• Tamiflu 75 mg capsule

• Tracleer 125 mg tablet

• Tracleer 62.5 mg tablet

• Udenyca 6 mg per 0.6 mL prefilled syringe

• Venclexta 10 mg tablet

• Venclexta 100 mg tablet

• Venclexta 50 mg tablet

• Venclexta starting pack

• Xofluza 40 mg therapy pack

• Xofluza 80 mg therapy pack

Other updates

• None

March 2023

Additions

• Guaifenesin 100 mg/codeine 6.33 mg per 5 mL solution (quantity limit, age limit, OTC)

Removals: None

Other updates

• Advair Diskus 100 mcg/50 mcg per actuation (removed step therapy)

• Advair Diskus 250 mcg/50 mcg per actuation (removed step therapy)

• Advair Diskus 500 mcg/50 mcg per actuation (removed step therapy)

• Advair HFA 115 mcg/21 mcg per actuation (removed step therapy)

• Advair HFA 230 mcg/21 mcg per actuation (removed step therapy)

• Advair HFA 45 mcg/21 mcg per actuation (removed step therapy)

• Dulera 100 mcg/5 mcg per actuation (removed step therapy)

• Dulera 200 mcg/5 mcg per actuation (removed step therapy)

• Dulera 50 mcg/5 mcg per actuation (removed step therapy)

• Pregabalin 100 mg capsule (removed prior authorization, updated quantity limit)

• Pregabalin 150 mg capsule (removed prior authorization, updated quantity limit)

• Pregabalin 20 mg per mL solution (removed prior authorization, updated quantity limit)

• Pregabalin 200 mg capsule (removed prior authorization, updated quantity limit)

• Pregabalin 225 mg capsule (removed prior authorization, updated quantity limit)

• Pregabalin 25 mg capsule (removed prior authorization, updated quantity limit)

• Pregabalin 300 mg capsule (removed prior authorization, updated quantity limit)

• Pregabalin 50 mg capsule (removed prior authorization, updated quantity limit)

• Pregabalin 75 mg capsule (removed prior authorization, updated quantity limit)

• Symbicort 160 mcg/4.5 mcg per actuation (removed step therapy)

• Symbicort 80 mcg/4.5 mcg per actuation (removed step therapy)

February 2023

Additions

• Dificid 200 mg tablet (prior authorization)

• Dificid 40 mg/mL suspension (prior authorization)

• Ethacrynic acid 25 mg tablet

• Fluocinolone acetonide 0.01% otic oil (quantity limit, OTC)

• Lactobacillus extra strength capsule (OTC)

• Miconazole nitrate vaginal suppository 1200 mg and 2% cream kit (OTC)

• Phenylephrine 10 mg/dextromethorphan 18 mg/guaifenesin 200 mg per 15 mL liquid (quantity limit, OTC)

• Pramoxine hydrochloride (perianal) 1% foam (quantity limit, OTC)

• Probiotic capsule (OTC)

• Pseudoephedrine 30 mg/dexchlorpheniramine 1 mg/chlophedianol 5 mg per 5 mL liquid (quantity limit, OTC)

• Refresh Relieva 0.5/1% preservative free ophthalmic solution (OTC)

• Sodium fluoride 1.1%/5% gel

• Xifaxan 550 mg tablet (prior authorization)

Removals

• Benzocaine 20 mg/docusate sodium 283 mg rectal enema

• Bisacodyl 10 mg/30 mL enema (OTC)

• Brimonidine tartrate 0.2%/timolol 0.5% ophthalmic solution

• Celontin 300 mg capsule

• Colchicine 0.6 mg capsule

• Ibrance 100 mg tablet

• Ibrance 125 mg tablet

• Ibrance 75 mg tablet

• Levofloxacin 0.5% ophthalmic solution

• Magnesium hydroxide concentrate 2400 mg/10 mL

• Naproxen delayed release, enteric coated 500 mg tablet

• Pirfenidone 267 mg capsule

• Potassium citrate 550 mg/sodium citrates 500 mg/citric acid 334 mg per 5 mL solution

Other updates

• Azelastine HCl 0.05% ophthalmic solution (removed step therapy)

• Celecoxib 100 mg capsule (removed step therapy)

• Celecoxib 200 mg capsule (removed step therapy)

• Celecoxib 400 mg capsule (removed step therapy)

• Celecoxib 50 mg capsule (removed step therapy)

• Vancomycin HCl 125 mg capsule (removed prior authorization, added quantity limit)

• Vancomycin HCl 250 mg capsule (removed prior authorization, added quantity limit)

January 2023

Additions

• Dupixent pen-injector 200 mg/1.14 mL solution (prior authorization)

• Dupixent pen-injector 300 mg/2 mL solution (prior authorization)

• Dupixent prefilled syringe 100 mg/0.67 mL solution (prior authorization)

• Dupixent prefilled syringe 200 mg/1.14 mL solution (prior authorization)

• Dupixent prefilled syringe 300 mg/2 mL solution (prior authorization)

• Eucrisa 2% ointment (prior authorization)

• Pimecrolimus 1% cream (prior authorization)

• Berinert kit 500 unit (prior authorization)

• Cinryze vial 500 unit (prior authorization)

• Firazyr syringe 30 mg/3 mL (prior authorization)

• Kalbitor vial 10 mg/mL (prior authorization)

• Orladeyo 110 mg capsule (prior authorization)

• Orladeyo 150 mg capsule (prior authorization)

• Symfi Lo 400 mg/300 mg/300 mg tablet

• Symfi 600 mg/300 mg/300 mg tablet

• Triumeq PD 60 mg/5 mg/30 mg soluble tablet

• Vfend 40 mg/mL suspension

• Ella 30 mg tablet (quantity limit)

• Tafluprost (PF) ophthalmic 0.0015% suspension

Removals

• Invirase 200 mg capsule

• Invirase 500 mg tablet

• Stavudine 15 mg capsule

• Stavudine 20 mg capsule

• Stavudine 30 mg capsule

• Stavudine 40 mg capsule

• Viracept 250 mg tablet

• Viracept 625 mg tablet

• Zioptan ophthalmic 0.0015% solution

• All Non-OneTouch Delica and Delica Plus Lancets and Lancet Devices

Other updates: None

December 2022

Additions

• Accutane 10 mg capsule

• Accutane 20 mg capsule

• Accutane 30 mg capsule

• Accutane 40 mg capsule

• Amnesteem 10 mg capsule

• Amnesteem 20 mg capsule

• Amnesteem 40 mg capsule

• Flonase nasal suspension 50 mcg/act

• Histex PD 0.938 mg/mL liquid (OTC)

Removals: None

Other updates: None

November 2022

Additions

• Imbruvica Susp 70 mg/mL (prior authorization, quantity limit)

• Orkambi Granule 75 to 94 mg (prior authorization)

Removals: None

Other updates: None