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Pharmacy

Choose the pharmacy coverage for you

New in 2027!

Your pharmacy coverage is moving from CVS Caremark to Express Scripts, Inc. (ESI), effective January 1, 2027. There are important changes being made to our prescription drug program that may impact your medications, pharmacy network, costs, and coverage requirements. To fully understand these changes and determine whether any action is needed on your part;

  • Contact Express Scripts directly by calling 866-716-7374 on or after October 19

2026 Coverage:

Through December 31, 2026, pharmacy coverage is provided through CVS Caremark. You are automatically enrolled in the pharmacy plan when you enroll in any of the Boston Children’s Medical Plans.  

Coverage Overview

Employees who take a GLP-1 for weight loss will see an increase in their copay.

Category

Blue Basic
HMO

Blue Plus
HMO

Blue Premium
PPO

Blue Essentials HDHP + HSA

Boston Children’s On-Site Pharmacy Mail Order
(90-day supply)

$10 Tier 1

$60 Tier 2

$135 Tier 3

10% coinsurance after deductible

Boston Children’s On-Site Pharmacy (30-day supply)

$5 Tier 1

$25 Tier 2

$45 Tier3

10% coinsurance after deductible

Retail/Mail Order
(90-day supply)

$25 Tier 1

$75 Tier 2

$150 Tier 3

20% coinsurance after deductible

Retail
(30-day supply)

$10 Tier 1

$30 Tier 2

$50 Tier 3

20% coinsurance after deductible

Mail Order Program

New for 2027!

You will continue to have access to the mail order program through Express Scripts. Your covered mail-order prescriptions will transfer automatically.

2026 Coverage:

If you use a long-term medication or are on a maintenance prescription that needs to be refilled regularly, you must refill for three months at a time. You can do this either at a CVS, through Caremark’s (retail) mail order pharmacy, or at the on-site pharmacy.

PillarRx

New for 2027!

Specialty medications will be available through Accredo® Specialty Pharmacy or Boston Children’s Pharmacy. If you take medication for complex conditions, such as cancer, a bleeding disorder, an inflammatory condition, or hepatitis C, you can fill it through Accredo or BCH. You will also have 24/7 access to specialty-trained pharmacists and nurses who can answer questions and help you manage your condition. PillarRx will continue to be available for copay assistance.

2026 Coverage:

For certain qualifying specialty medications, Boston Children’s partners with PillarRx, who assists members covered under the hospital’s pharmacy plan to obtain copay assistance from drug manufacturers to reduce out-of-pocket expenses.

View this FAQ for details.

CVS Weight Management Program

New for 2027!

Beginning January 1, 2027, if you are prescribed a GLP-1 medication for weight loss, participation in the CVS Weight Management Program will no longer be required. As part of our ongoing commitment to supporting your health and wellbeing, Zepbound and Fundayo are now covered. In order to continue to provide coverage, this change will also include a copay increase to $75.

Get help achieving your weight-loss goals with Grokker’s GLP-1 Success Course. This is a free program hosted by Tarah, a Registered Dietitian. You can participate in daily activities, weekly webinars, personal coaching and private messaging. It can be as flexible as you need it to be – make it work for you!

2026 Coverage:

Boston Children’s covers GLP-1 medications under CVS Caremark’s formulary. As part of this covered benefit, the CVS Weight Management program will partner with you to help you reach your goals using various tools to address overall health and wellbeing.

New prescribers, watch your mail for registration and details to participate so you may receive the covered rate for your GLP-1. View this FAQ for details.

Use the Boston Children’s Pharmacy

The Boston Children’s Hospital Pharmacy is available to fill your prescriptions — including adult prescriptions for maintenance and acute medications. The pharmacy is conveniently located at 283 Longwood Avenue, Boston, and open from 8 a.m. to 11 p.m. seven days a week. You can receive free home delivery if you live in New England or New York!

Read your pharmacy FAQ document for more information and answers to your questions.