Pharmacy Benefits: Optum Rx Replaced by CVS Caremark
As of January 1, 2026, CVS Caremark (CVS) replaced OptumRx as the new pharmacy benefits manager (PBM) for the CalPERS health plans listed below. For Medicare members, SilverScript – an affiliate of CVS – is administering your pharmacy benefits.
The CVS microsite Caremark.com/CalPERS and phone lines are open 24 hours, 7 days a week. Contact CVS or SilverScript if you have any questions about your pharmacy benefits.
- CVS Customer Care: (833) 291-3649
- SilverScript Customer Care for Medicare members: (833) 291-3648
Both Basic plan and Medicare members can access important information about their prescription benefits through Caremark.com and the CVS health app, including digital tools like a pharmacy locator search feature to find in-network pharmacies. These online resources will also enable members to verify the formulary status of a specific medication.
Formulary & Exclusions Lists
You can review the formulary and exclusions lists for Basic plans and Medicare to verify the status of your specific medication.
- Basic Plan Formulary (PDF)
- Basic Plan Exclusions (PDF) – list of Medications that are no longer covered on the Basic formulary as of January 1, 2026. For all excluded drugs, safe and effective alternatives are available.
- Medicare Plan Formularies (formularies are the same across Medicare plans; however, lists are separated for ease of reference)
- Medicare Exclusions – list of medications that are no longer covered on the Medicare formulary as of January 1, 2026. These exclusions apply to all SilverScript-covered Medicare plans. For all excluded drugs, safe and effective alternatives are available.
Plans covered by CVS Caremark:
- Basic Plans
- Anthem Blue Cross Traditional
- Anthem Blue Cross Select
- Health Net Salud y Más
- PERS Gold
- PERS Platinum
- Sharp Health Plan Performance Plus
- UnitedHealthcare SignatureValue Alliance
- UnitedHealthcare SignatureValue Harmony
- Western Health Advantage
- Medicare Plans
- Anthem Blue Cross Medicare Preferred
- PERS Gold Medicare Supplement
- PERS Platinum Medicare Supplement
The following plans are not impacted by the PBM change:
- Basic Plans
- Blue Shield Access+ (HMO and EPO)
- Blue Shield Trio
- Kaiser Permanente
- Kaiser Permanente Out-of-State
- Medicare Plans
- Blue Shield Medicare
- Kaiser Permanente Senior Advantage
- Kaiser Permanente Senior Advantage Out-of-State
- Kaiser Permanente Senior Advantage Summit
- Kaiser Permanente Senior Advantage Summit Out-of-State
- Sharp Direct Advantage
- UnitedHealthcare Group Medicare Advantage
Both Basic plan and Medicare members will be able to access important information about their prescription benefits through Caremark.com and the CVS health app, including digital tools like a pharmacy locator search feature to find in-network pharmacies. These online resources will also enable members to verify the formulary status of a specific medication.
Pharmacy Benefits Manager Webinar
We hosted a webinar on Thursday, September 18, 2025. The recording is available, now, on YouTube.
Frequently Asked Questions
General Transition Information
A PBM is a third-party vendor that CalPERS contracts with to help manage your prescription drug benefits for certain health plans. They handle services like processing pharmacy claims, managing the list of covered medications known as the formulary, negotiating drug prices, and providing you tools and programs to help you manage your prescriptions.
This change was made to enhance our pharmacy services and better manage your prescription benefits. CalPERS chose CVS Caremark because of its strong commitment to performance guarantees in key areas such as managing pharmacy costs, ensuring clinical quality, and increasing transparency. This change was designed to provide you with high-quality service while ensuring your access to safe and effective medication.
SilverScript is an affiliate of CVS Caremark and administers pharmacy benefits for our Medicare members.
SilverScript is the Medicare Part D plan name and administers pharmacy benefits for our Medicare members – the main difference between SilverScript and CVS Caremark is branding.
Yes, the information below applies to both Basic and Medicare members.
No. All members now receive pharmacy benefits through CVS as of January 1, 2026.
No immediate action is needed. You should have received additional information about your new prescription benefit. You should have received a welcome kit that includes a QR code that allows you to register on Caremark.com and use the CVS Health app.
Pharmacy Network
CVS Caremark’s retail pharmacy network is national in scope and is comprised of more than 64,000 pharmacies, including major chains, regional pharmacies, and independents. While rare, there could have been some changes to your retail pharmacy (e.g., due to pharmacy closures). You can search whether a specific pharmacy is in network using CVS’s pharmacy locator and Caremark.com/CalPERS.
Most retail pharmacies will remain accessible through CVS Caremark. If your pharmacy is impacted, you should have received a letter notifying you of the change approximately 30-60 days prior to the effective date of January 1, 2026.
Prescription Transition
In most cases, you’ll continue to order prescriptions at your preferred retail pharmacy (e.g., CVS, Walgreens, Safeway, VONS, etc.). However, there may be some changes to the list of covered drugs or changes to in-network pharmacies. Additionally, mail order prescriptions and specialty pharmacy prescriptions will be dispensed through CVS Caremark pharmacies, instead of OptumRx pharmacies.
Non-controlled prescriptions with refills remaining that were filled at OptumRx mail and specialty pharmacies automatically transferred to CVS Caremark. Some prescriptions may require a new prescription from your doctor, such as controlled substances or expired refills. CVS will notify you if action is needed. Medicare members utilizing a specialty pharmacy will receive a letter with information about options.
Some medications may have different approval requirements under the new PBM. If you currently have an active approved prior authorization, it’ll transfer automatically to CVS.
Yes. The mail order pharmacy will change, but mail order delivery will continue to be an option. Most mail order prescriptions will transfer automatically, and you’ll receive instructions on how to place your first order.
Many prescriptions transferred automatically to the new mail order pharmacy (CVS Caremark). Some medications may require a new prescription from your doctor, such as controlled substances or expired refills. You’ll be notified if action is needed.
For prescriptions that can’t be transferred, such as controlled substances or prescriptions with no remaining refills, contact your prescriber or CVS Caremark if you are in a Basic plan or SilverScript if you are on Medicare.
Yes. You’ll need to provide your new ID card to the pharmacy.
Your physician can request a medical necessity exception for your medication if it’s no longer covered but they believe it’s the most effective medication for your condition. Additionally, for Basic plans, if you need more time to make a change from your excluded drug to a preferred medication, members can call CVS's dedicated team and request a 90-day transition fill. For Medicare plan members impacted by the formulary change, there’ll be a 90-day transition period for filling prescriptions, prior to being switched to an equally safe and effective alternative medication.
Yes. Specialty medications are now filled through CVS specialty pharmacies.
Formulary Changes
If impacted, you should have received detailed information approximately 30-60 days prior to the effective date of January 1, 2026.
The formulary and exclusions lists, as well as CVS’s formulary search tool, for Basic plans and Medicare are available now:
- Basic Plan Formulary (PDF)
- Basic Plan Exclusions (PDF) – list of medications no longer covered on the Basic formulary as of January 1, 2026. For all excluded drugs, safe and effective alternatives are available.
- Medicare Plan Formularies (formularies are the same across Medicare plans; however, lists are separated for ease of reference)
- Medicare Exclusions (PDF) – list of medications no longer covered on the Medicare formulary as of January 1, 2026. These exclusions apply to all SilverScript-covered Medicare plans. For all excluded drugs, safe and effective alternatives are available.
There may be updates to the formulary, including changes to covered medications. If your medication is impacted, you’ll be notified by mail and provided additional information, including alternative options, to discuss with your doctor.
Yes. All excluded medications have an equally safe and effective alternative medication on the new formulary.
It’s possible that some medications changed tiers in the new formulary which result in changes to copayments.
A formulary change refers to modifications made to the list of covered prescription drugs, known as the formulary. These changes can involve adding, removing, or reclassifying drugs, as well as adjusting prior authorization or step therapy requirements.
If your medication is affected by a formulary change – for example, no longer covered or moved to a higher tier, you should have received a personalized letter approximately 30-60 days before the January 1, 2026. This letter included:
- Covered alternatives
- Next steps if you need to request a formulary exception
- How to speak with your doctor about switching medications
Member Support
CVS welcomes CalPERS members who would like to call and speak with a live representative. Representatives are able to provide members with more information about their new prescription benefits. CVS phone lines are open 24 hours, 7 days a week.
Basic plan members can call CVS Customer Care: (833) 291-3649.
Medicare plan members can call SilverScript Customer Care: (833) 291-3648.
You’ll receive information about how to access important information online at www.Caremark.com/CalPERS and through the CVS Health app, including tools like a pharmacy locator search feature to find in-network pharmacies.
No, most members won’t experience any disruption from this change. Your current pharmacy benefits will continue as usual.
Basic plan members should have received a new member ID card from their health plan with updated pharmacy information.
Medicare members should have received a new member ID card from SilverScript.
You should have received a new ID card a few weeks before January 1, 2026. Be sure to monitor your mailbox and use this card for all prescription services as of January 1, 2026.