Pharmacy Network, Formulary, and Part D Details

Prescription Web Portal by Caremark

This is the most comprehensive way to get pharmacy and formulary information. Sign in to the Clover Member Portal and then click on the Prescription Web Portal by Caremark. 
 

Key Highlights

• Check Drug Cost, Formulary Coverage, and Coverage Determination Status
• Manage Prescriptions and Check Order Status
• Opt-in for Paperless Part D Explanation of Benefits (EOB)
• Check In-Network Pharmacies Near You
   

Changes to Our Formulary

Clover Health may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.

We must alert members taking a certain drug if we make any of these changes:

• Remove the drug from our formulary
• Add prior authorization for the drug  
• Add quantity limits and/or step-therapy restrictions on the drug
• Move the drug to a higher cost-sharing tier
• If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
• If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.

Medication Therapy Management (MTM) Program

Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members, doctors and pharmacists to help provide the greatest benefit from their medications.