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Dear CaliforniaChoice Broker,

We are reaching out to make you aware of a change that impacts members enrolled in Sutter Health Plus. We are notifying you first and will email your CaliforniaChoice groups this afternoon at 3:00 p.m.

Sutter Health Plus New Pharmacy Benefit Manager – CVS Caremark®

Effective January 1, 2022, Sutter Health Plus is changing its pharmacy benefit manager (PBM) to CVS Caremark from Express Scripts®. CVS Caremark will manage the pharmacy benefits for members enrolled in Sutter Health Plus, including retail, mail order, and specialty prescription drugs, claims processing, and prior authorization requests for drugs.

Sutter Health Plus mailed all subscribers a letter about the PBM change on November 1. The letter provided details about the transition, including new mail order and specialty pharmacy vendors, basic information regarding the Sutter Health Plus Formulary, and contact information for CVS Caremark.

The letter includes a reference to “Pending Regulatory Approval.” Adding this reference allowed Sutter Health Plus to provide timely notice about the transition to CVS Caremark, while the Department of Managed Health Care (DMHC) completes its review of the PBM transition.

To ensure members continue to receive their drugs with minimal disruption, Sutter Health Plus is transferring member prescription history, including claims information and any active prior authorizations, to CVS Caremark. Sutter Health Plus is also transferring active and refillable mail order and specialty prescriptions.

If you have additional questions regarding this change, please contact Sutter Health Plus Account Services at 855.325.5200, visit www.sutterhealthplus.org/pharmacy, or email shpbroker@sutterhealth.org.

If you have any questions about your CaliforniaChoice business, please contact our Customer Service Team at 800.558.8003.

Thank you for your business,

CaliforniaChoice


 
 
721 South Parker, Suite 200
Orange, CA 92868
800.558.8003
 
 
 
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