PAI has several programs in place to ensure that members with Caremark as their pharmacy benefit manager have access to their prescriptions in a way that is both safe and at the lowest cost.
Not all benefit plans are the same. Please check your benefit information to find out which programs apply to you.
Opioid Management Program
The Opioid Management program applies to all members and consists of daily quantity limits specific to each covered opioid drug and prior authorization requirements for certain prescribing situations. Learn how the Opioid Management Program works and which drugs are included in the program.
Most of our members need prior authorization for certain drugs. You can find out what these drugs are by viewing our Prior Authorization Drug List.
This program limits the amount of certain drugs a member’s plan will cover. You can see which drugs have quantity limits by viewing our Quantity Management Drug List.
Step Therapy requires members to try cost‐effective “First Choice” medications before trying (or "stepping up to") more expensive “Second Choice” medications. Many people find the First Choice medications work just as well for them. View the Step Therapy Drug List.