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HSCSN Pharmacy Benefits

Find a drug or pharmacy

Health Services for Children with Special Needs, Inc. (HSCSN) provides you pharmacy benefits through CVS Health. Learn about your benefits, including how to find a drug and a pharmacy. For more information about your pharmacy benefit, call the CVS Customer Care Team at (866) 885-4944. You can also contact HSCSN Customer Care at (202) 467-2737. Please check the list of frequently asked questions below.

List of Covered Drugs (Preferred Drug List)

As of July 1, 2019, all HSCSN enrollees have access to a list of covered drugs, called a Preferred Drug List. A Preferred Drug List is a list of medications that may be prescribed by your doctor. The Preferred Drug List is revised every six months. The website will be updated to reflect these changes. We will notify you of any updates to the drug list. You may request a printed copy of the drug list by contacting HSCSN Customer Care at (202) 467-2737

 

Pharmacy Benefits

CVS Locations (In-Network)

To view all in-network pharmacies, please download the full list here. HSCSN updates this list regularly.

To Get a Prescription Filled

  • Pick a pharmacy that is part of the CVS Health network and is close to your work or home.
  • Take your HSCSN Enrollee ID Card with you to the pharmacy. The pharmacy will contact HSCSN for other information needed to fill your prescription.
  • Please note, your pharmacy should never ask you to pay for your medicines. Call HSCSN Customer Care at (202) 467-2737.  if the pharmacy or drug store asks you to pay.
  • If you have any additional questions, please call Customer Care.

If you do not have your current Enrollee ID Card:
When you go to fill your prescription, tell the pharmacy to call HSCSN Customer Care at (202) 467-2737. They will look up your Enrollee ID number and share it with your pharmacy.

If you need help or have questions:
Call CVS Customer Care at (866) 885-4944.

Prior Authorizations

If the drug you need on the Preferred Drug List is listed but not covered, your doctor must submit a request for coverage. This is called prior authorization (PA). The drug list indicates which drugs need prior authorization.

While you are waiting for an approval of the drug, you have a right to get the drug:

  • For up to 7 days or
  • For one full round of the medicine if you take it less than once a day

For more information about how to get coverage through PA, please contact your doctor. If you need to get a drug that is not listed, and your doctor cannot find a substitute on the list, your doctor can submit an exception request for the drug to CVS Utilization Management Department at (877) 433-7643.

Formulary Exceptions

You can make a one-time request to have a drug that is not on the drug list to be covered for you. To make an exception request please call your doctor.

Frequently Asked Questions

Q: What should I ask my pharmacist?
A:
Here are things you should ask:

  • What is my medicine used for?
  • What should my health care professional know before I take my medicine?
  • How should I take my medicine(s)?
  • What if I miss a dose of my medicine?
  • What other prescription medications, over-the-counter medicines or foods may interact with my prescription?
  • Why does medicine look different than it did before?
  • Is my medicine a generic?

Q: How do I get a drug that requires Prior Authorization (PA)?
A:
Please contact your doctor. They must make the request to get Prior Authorization for the drug.

Q: What is a generic drug?
A:
A generic drug is the same as a brand-name drug in:

  • dosage, strength, safety, quality,
  • the way it works,
  • the way it is taken and
  • the way it should be used.

Q: Are generic drugs as strong as brand name drugs?
A:
Yes. The government requires generic drugs to be equal to brand name drugs in quality, strength, purity, and stability.

Q: Why would my doctor choose a generic over a brand name?
A:
  Generic drugs are proven to be as safe and effective as brand name. They also typically cost much less than brand name drugs.

We Want to Hear From You

For More Information (Enrollees):

If you have any questions about your pharmacy benefits or the drug formulary (Preferred Drug List), please contact CVS Customer Care at (866) 885-4944. You can also contact Health Services for Children with Special Needs, Inc. (HSCSN) Customer Care at (202) 467-4737.

For More Information (Providers):

If you have questions about the drug formulary, please visit the “For Pharmacists and Medical Professionals” page on the CVS Caremark website or contact the CVS Utilization Management Department at (877) 433-7643. You can also call the HSCSN Customer Care Team at (202) 467-4737.