New Pharmacy Benefits Manager

We’re introducing a new pharmacy benefits manager, Capital Rx, which will be available to you if you enroll in a CareFirst medical plan. Noted for its award-winning customer service, Capital Rx will process prescription drug claims on your behalf beginning January 2024. Capital Rx will also:

• Negotiate low drug costs and rebates with pharmaceutical manufacturers
• Create and administer retail pharmacy networks
• Develop and maintain formularies, which are lists of covered drugs
• Provide mail pharmacy services through Optum RX
• Provide specialty medications through Optum RX or Johns Hopkins Onsite Pharmacy (there will be a 90 day continuation for current patients)
• Ensure clinically appropriate drug use

If you enroll in a CareFirst medical plan, you’ll receive one medical ID card that includes information about your medical and pharmacy benefits.

Wondering if one of your medications is covered by Capital Rx? Find out if your prescriptions are on the formulary—i.e., Capital Rx’s list of approved drugs—and search for approved pharmacies.

You can also review Capital Rx’s:

• Approved preventive medications
• Medications that require prior authorization
• Approved pharmacies

Kaiser Permanente Prescription Drug Coverage

If you choose to continue with the Kaiser Permanente HMO Plan for your medical coverage, Kaiser Permanente will continue to manage your prescription drugs.