CalChoice: Sutter Health Plus Announces CVS Caremark as New PBM

CaliforniaChoice sent the following information to brokers and groups about Sutter Health Plus and their new 2022 Pharmacy Benefit Manager, CVS Caremark®.

Sutter Health Plus New Pharmacy Benefit Manager – CVS Caremark®

Effective January 1, 2022, Sutter Health Plus is changing its pharmacy benefit manager (PBM) to CVS Caremark from Express Scripts®. CVS Caremark will manage the pharmacy benefits for members enrolled in Sutter Health Plus, including retail, mail order, and specialty prescription drugs, claims processing, and prior authorization requests for drugs.

Sutter Health Plus mailed all subscribers a letter about the PBM change on November 1. The letter provided details about the transition, including new mail order and specialty pharmacy vendors, basic information regarding the Sutter Health Plus Formulary, and contact information for CVS Caremark.

The letter includes a reference to “Pending Regulatory Approval.” Adding this reference allowed Sutter Health Plus to provide timely notice about the transition to CVS Caremark, while the Department of Managed Health Care (DMHC) completes its review of the PBM transition.

To ensure members continue to receive their drugs with minimal disruption, Sutter Health Plus is transferring member prescription history, including claims information and any active prior authorizations, to CVS Caremark. Sutter Health Plus is also transferring active and refillable mail order and specialty prescriptions.

If you have additional questions regarding this change, please contact Sutter Health Plus Account Services at 855.325.5200, visit www.sutterhealthplus.org/pharmacy, or email shpbroker@sutterhealth.org.