CVS Caremark GLP-1 prior authorization in 2026.
Roughly 110 million US covered lives in 2026. Used by Aetna (when carved in) and others.
Plans administered by CVS Caremark
- Aetna (when carved in)
- FEHB BCBS Federal Employee Program
- Anthem affiliates in select states
- Many large-employer self-insured plans
The CVS Caremark step-therapy quirk you should know about
Caremark frequently requires step therapy through phentermine or orlistat for obesity-indication PAs even when the underlying plan does not list a step-therapy requirement. Submit the step-therapy attestation upfront (prior trial documented, intolerance documented or contraindication documented) to avoid the reflexive denial.
Expert tip
If your plan card says 'CVS Caremark' on the back, your PA decision is made at Caremark, not at your health plan. The Caremark formulary takes precedence over your plan's medical policy on drug coverage decisions. Send the letter to the Caremark fax number, not the health plan.
The right plan-by-condition templates for CVS Caremark
Pick the template that matches your specific health plan and your qualifying indication. The plan and condition determine the PA criteria; the PBM determines how the letter is reviewed and submitted.
Other PBMs
