U.S. Prescriptions Funded Program
Your U.S. out–patient prescription drug benefit is designed
to support you when you purchase prescription medications in the U.S. With your Bupa Global insurance (ID) card, if you have a co-payment for eligible medications, you will pay only that, at time of purchase, so long as you have used a Participating Pharmacy. We will settle our part of the cost directly — so you don’t have to worry about collecting receipts or making a claim for reimbursement.
For information on claims outside of the network visit FAQ's
The CVS/caremark Performance Drug List defines the co-payment
tier status of the medicines most commonly prescribed.
How does the U.S. Prescription Funded Program work?
All you need to do is pay the appropriate co-payment, if applicable, (details of your
co-payment or deductible can be found in your membership guide) and collect your prescription. This only applies for participating pharmacies.
What does it mean when a pharmacy says they do not participate?
CVS/caremark offers members with access to the Funded Program a network of over 68,000 participating pharmacies. A participating pharmacy is one who has contracted with CVS/caremark to provide prescription services to CVS/caremark members. If a pharmacy has not contracted with CVS/caremark to provide such services, any prescription claims attempted to be filled by this pharmacy will “reject” or, not process using the member’s benefits. Members need to pay and claim for covered medications at non-participating pharmacies. The Pharmacy can call the Pharmacy Help Desk number located on the member’s Bupa Global insurance (ID) card to discuss the process and requirements to become enrolled as a participating pharmacy.
May I obtain my medications from a non-participating pharmacy?
With an extensive pharmacy network of over 68,000 participating pharmacies, it is easier to find a pharmacy in the CVS/caremark network than out of the network. If you choose to utilize a non-participating pharmacy, you will pay 100% of the cost of the medication out of pocket. If your benefits plan allows, you may submit a reimbursement claim form along with the original pharmacy receipt; however, this option will usually cost you more than using a participating pharmacy.
When do I need to use the CVS/caremark Direct Reimbursement Form?
If a prescription medication is purchased outside the pharmacy network or you purchase a prescription from a pharmacy within the Universal network but do not present your Bupa Global insurance (ID) card, you will need to submit the CVS/caremark Direct Reimbursement Form along with the original detailed prescription receipt to request reimbursement. Please note that reimbursements will be made in USD checks only.
Are over-the-counter medications covered as part of my prescription benefits?
Most over-the-counter medications are not covered as part of your U.S. prescription benefits plan. If there are over-the-counter alternatives to a prescribed medication, the prescribed medication may not be covered under the plan. Please refer to your U.S. Pharmacy Guide for additional information. For specific coverage questions, please contact the Pharmacy Help Desk on 1-800-237-2767.
What if I lose my Bupa Global insurance (ID) card or do not have it with me and need a prescription filled right away?
Members are encouraged to carry their Bupa Global insurance (ID) card with them at all times. However, in situations where your card is not at hand and you need to purchase your medication immediately, the pharmacist can call the Pharmacy Help Desk at 1-800-237-2767 to obtain all the necessary information to verify your eligibility, plan of benefits and process the claim.
If I misplace my Bupa Global insurance (ID) card how can I obtain a new one?
You can request a new card by calling your Bupa Global customer services team, advising your Group Secretary or by logging onto your Bupa Customer portal.
Do prices vary among participating pharmacies?
CVS/caremark contracts a price with each pharmacy. Prices may vary from pharmacy
to pharmacy, but usually only slightly.
Does my doctor need to know about my prescription drug coverage when writing my prescription?
No; however, you should always consult with your doctor about prescription savings opportunities on prescription medications. This will ensure you are obtaining the most effective drugs for the least expensive price. Please show your physician the CVS/caremark Performance Drug List.
What is a Performance Drug List?
The 2 tier “performance drug list” provides a partial listing of the most commonly used medications and what co-payment tier the medications fall under. If your US pharmacy plan has a 2-tier co-payment structure, Tier 1 is for Generic medications and Tier 2 is for Brand medications. If a medication is not on the list, you may contact the Pharmacy Help Desk at 1-800-237-2767 to determine which tier your medication falls under.
Should I ask my doctor to approve a generic substitution whenever possible?
Yes, a generic drug is a copy of the brand name medication and typically offers a substantial savings over the brand name drug. The generic drug is preferred if your physician has confirmed it is acceptable for you to take it. By using the generic drug, it saves both you and your employer money.
My doctor prescribed a brand medication. Why did I receive a generic?
This means the box marked “may substitute” was checked on the prescription. If this box is checked, it means your physician has allowed the pharmacy to substitute the generic drug when there is one available.
How do I transfer my prescription from a non-participating pharmacy to a CVS/caremark participating pharmacy?
You may ask the pharmacist at your new participating pharmacy to contact the old non-participating pharmacy
and request a transfer of the prescription.
Where can I get a summary of my benefits?
You can contact the Bupa Global Customer Service number on your Bupa Global insurance (ID) card or access online documents via your Bupa Customer portal.
What are your customer service hours?
The Pharmacy Help Desk hours are:
Monday–Friday, 6:30am-8:00pm (CT)
When do I need a Prior Authorization?
Specialty Prescribed Drug Products are drugs/pharmaceuticals or category of drugs/pharmaceuticals, that will require your physician to contact the pharmacy in advance to provide additional information for coverage approval purposes. These medications generally meet most of the following criteria:
1. are produced through biotechnology or recombinant DNA technology mechanisms;
2. are high cost (typically over USD 250 per dose or USD 1000 per month of therapy);
3. are generally, but not always, administered by injection;
4. require specialized patient monitoring, special handling, or unique education prior to use;
5. have restricted distribution procedures.
Examples of drugs that qualify as Specialty Prescribed Drug Products include, but are not limited to, drugs/pharmaceuticals that are used to treat Crohn’s disease, hemophilia, growth hormone deficiency, RSV, cystic fibrosis, multiple sclerosis, hepatitis C, rheumatoid arthritis, and Gaucher’s disease.
Your prescribing physician will need to submit a completed prior-authorization form to our service partner CVS/caremark.