Frequently Asked Questions (FAQs)
CarolinaCARE
All mail should be sent to:
P.O. Box 31691
Charlotte, NC 28231-1691
Physical address:
4400 Golf Acres Drive • Building J Suite C
Charlotte, NC 28208
Phone: 704-512-6800 (toll free, 866-697-6800)
Members Fax: 704-371-7280 (toll free, 866-307-9670)
Physicians Fax: 704-512-6801 (toll free, 866-307-9668)
(Note: Only physicians can fax new prescriptions to CarolinaCARE).
General Questions
Who is CarolinaCARE?
CarolinaCARE is your mail order pharmacy owned and operated by Carolinas Healthcare System. By CHS Plan design, the mail-order program continues to be a mandatory option for maintenance medications.
You may save both time and money by using CarolinaCARE and the CHS owned retail pharmacies for both new prescriptions and for refills. Medical Center Plaza Pharmacy (MCP), Matthews Medical Plaza Pharmacy, CMC-Northcross Pharmacy, and CMC-Morrowcroft Pharmacy locations are "retail" sites. They can fill only 30-day supplies of medication, and only up to three total fills of any maintenance prescription (after three fills, you must fill the prescription through the CarolinaCARE mail order pharmacy).
If more convenient, you may also use a neighborhood retail pharmacy to fill your 30-day prescription (i.e., Rite-Aid, Wal-Mart, Walgreens, CVS, etc). Co-pays may be slightly higher than the CHS-owned retail pharmacies.
When appropriate, it may be a good idea to ask your physician for two written prescriptions - a 30-day supply to be filled at your local retail pharmacy or CHS reatil pharmacy; and a 90-day prescription to submit immediately to CarolinaCARE, your mail order facility.
Prescriptions mailed to your home or post office box require payment in advance of shipping. Please make sure you that you indicate a payment option each time an order is submitted to CarolinaCARE. All payment information is both secure and confidential.
CarolinaCARE partners with WHI (a Pharmacy Benefits Manager). Together, the two vendors work closely to administer your prescription benefit as designed by CHS Human Resources and the CHS Benefits Committee.
Is my healthcare information confidential, since CarolinaCARE is CHS owned and operated?
Yes. Employees of CarolinaCARE are bound by the same high confidentiality standards as are all CHS employees. Access to your prescription profile and healthcare database is limited to the Pharmacy staff who are directly involved in processing your prescriptions. Federal HIPAA guidelines are strictly enforced when providing healthcare to employees, just as enforcement is mandated with all clientele of Carolinas HealthCare System.
Where can I get more information about my pharmacy benefit?
For more information, you may consult:
- CarolinaCARE Customer Service line at: 704-512-6800 or toll-free at 866-697-6800
- HR Express (Synapse)
- HR enrollment guide
- CarolinaCARE website (www.carolinacarerx.org)
Must I use CarolinaCARE for maintenance medication?
Yes. Maintenance medications (drugs taken on an ongoing basis, excluding some controlled substances) are limited to three fills at a retail pharmacy (CVS, Walgreens, Rite-Aid, etc. and CHS-owned retail pharmacies). After a maximum of three fills (the original plus two refills) the prescription must be purchased through CarolinaCARE.
What is the mailing address for CarolinaCARE?
All correspondence for this mail order facility should be addressed to:
CarolinaCARE
P.O. Box 31691
Charlotte, NC 28231-1691
What is the best source of information about CarolinaCARE?
By far, the CarolinaCARE website (www.carolinacarerx.org) is the most comprehensive source of information about your prescription benefit. From this site, you can access forms, order prescription refills, and request prescription transfers from retail pharmacies to CarolinaCARE.
You may also look up information about many drug products. A handy guide to over 2400 medication summaries is available on the CarolinaCARE website. Simply click on the link:
Look up drug information.
You may also download a copy of the CarolinaCARE copay guide as a reference to take with you to your physician's office. This guide lists the most commonly prescribed categories of medications. Remember - you can always contact a CarolinaCARE member services representative for the most up-to-date information on pricing.
What other information can I get from the CarolinaCARE website?
By registering on the website of our benefits partner, WHI, you can link to other information about CarolinaCARE. You will be able to locate all retail pharmacies within the WHI network, review prescription and refill information, check drug coverage and co pay information, and print a temporary ID card.
NOTE: You MUST access the WHI website by first logging onto the CarolinaCARE website in order to get the CHS specific information. A separate registration and password is required for both sites.
Medication Selection
How are medications selected for my plan?
The doctors and pharmacists of Carolinas Healthcare System review new drugs and existing drugs on a routine basis. Medications are selected based on effectiveness, safety, tolerability and cost.
Why do I sometimes get one medication when my doctor ordered something else?
This is evidence that the CarolinaCARE pharmacists are working on your behalf. If your doctor orders a medication that is not a generic or plan-preferred medication, and you check the box allowing the pharmacist to work with your doctor, you may receive a different drug. While it may be different, it will be the most effective and cost affordable medication covered by your Plan.
Why do some medicines require a preauthorization by my plan?
Many medications are approved to treat specific conditions only. The preauthorization is used as a safety measure. It is a method to verify with your doctor that you have been diagnosed with the condition that the drug is intended to treat. The pharmacists will work with you and your doctor to obtain the preauthorization as quickly as possible.
Why do some drugs on my Plan have limits on the amount of dosage units that I can get?
This is a safety measure. Many drugs are approved for only a limited duration of therapy. There may be maximum doses per day or week that should not be exceeded; or, the medication may require a dose adjustment based on specific criteria. The guidelines are established for drugs with these warnings. The limited supply is to protect you.
Receiving Your Medications
How do I use the mail order system?
Prescriptions for mail order may be requested in 5 ways:
- by intranet through Synapse (HR Express)
- by Internet through the CarolinaCARE Web site (www.carolinacarerx.og)
- by the toll-free, automated telephone system for CarolinaCARE - My Quik Refill Line (704-512-6800 or 1-866-697-6800)
- by mail, using the handy mail order form that is available online (www.carolinacarerx.org) and various locations throughout the System
- by faxed authorization directly from the physician's office only ( 704-512-6801)
Customer service representatives for CarolinaCARE are available from 9AM to 5PM, Monday through Friday, to answer any questions you may have about mail orders (704-512-6800 or 1-866-697-6800).
I forgot to request a refill and I am completely out of medication. How can I get enough medicine to last until my mail order is delivered?
In the unfortunate event you forget to reorder your medication in time for mail delivery, you can ask the pharmacist at your retail location to fill a small supply that will last until your mail order arrives(NOTE: the retail pharmacy must have a copy of your prescription on file). This small supply will need to be paid for out-of-pocket, but may be less expensive than filling the entire 30- or -90 day supply as an out-of-pocket expense.
Can I use the CVS or Wal-Green Pharmacy located next to my house?
Yes. In addition to the CHS owned pharmacies, you will be able to use local retail pharmacies throughout the region. Please refer to the WHI link (locate a pharmacy) on the CarolinaCARE website for a detailed listing of these stores and their locations. Remember: maintenance medications (those medications taken on an on-going basis to treat certain conditions) do have a three fill limit at all retail stores. Then, these medications must be filled through CarolinaCARE.
How do I pay for prescriptions that are sent in the mail? What if I send the wrong amount of money?
For prescriptions that are mailed, you may use a check, money order, credit or debit card, flexible spending account, or payroll deduction (example, GEMpay) as payment options. You can create a method of payment profile on the secured CarolinaCARE website. You can then select the preferred method of payment each time you submit a prescription order. If you do not have a credit/debit card, payroll deduction, or flexible spending account, and your check or money order is for the wrong amount, we will make every effort to contact you about the discrepancy.
How do I check the status of my prescriptions?
By the 4th quarter of 2008, the CarolinaCARE web site will display status information. We expect to provide status information on the web site and through email confirmation when your order ships. The CHS Applied Technology group is currently developing a plan that incorporates the tracking technology into the CarolinaCARE automation. Stay tuned to our website. We will update you on our progress through the CarolinaCARE homepage.
In the meantime, you can call the CarolinaCARE Member Service line (704-512-6800 or toll-free 866-697-6800) to check the status of your order. Before calling to check the status of a prescription, please allow up to 10-14 business days for mail order delivery of prescriptions.
Why can it take over a week to receive my prescriptions?
Certain situations can add to the time required to fill a prescription, such as when your CarolinaCARE pharmacist works to reduce your prescription cost by changing your prescription to a less expensive formulary agent; or, when your prescription reaches the maximum number of authorized refills. In cases such as these, your physician must be contacted. It can take several days before a response is received.
At this time, we ask that you please allow 10-14 business days for your CarolinaCARE pharmacist to work through the issues and for delivery of your order by mail. In every case, a CarolinaCARE representative will contact you when a delay is anticipated.
My physician has written multiple prescriptions on one form, but I don't need them all filled at once. What should I do?
CarolinaCARE will process all prescriptions that are submitted unless CLEARLY instructed to do otherwise. Ideally, please ask your physician to write those prescriptions which are not currently needed on a separate blank. This way, you can submit to CarolinaCARE only the prescriptions that you need. If, however, you have multiple prescriptions written on a single blank, clearly indicate which should be filled and which should be held by CarolinaCARE until further directions are received from you.
A downloadable form is available on the CarolinaCARE website to assist you in clearly marking which prescriptions are to be processed now, and which prescriptions should be held until further instructions are received. Please log in at www.carolinacarerx.org, and search for Forms.
What if my medication requires refrigeration?
CarolinaCARE ships all medications that require refrigeration by next day delivery through several shipping companies, including FedEx.. A CarolinaCARE representative will contact you by telephone in advance of shipment with notification of expected delivery time. Make sure you have up-to-date daytime contact information on file. Updates to your contact records can be submitted to CarolinaCARE at anytime through the website or the downloadable paper form. Permanent changes to the primary contact information, however, must be submitted through MY HR on Synapse.
Prescriptions and Coverage
How do I know if the medicine I take is covered by the plan?
Most medications are covered by your CHS prescription benefit. You may check your Medication Copay Guide, visit the CarolinaCARE Web site and click on Medication Copay Guide or the link Check Drug Coverage/Co pay, or click on HR Express on Synapse for a complete formulary listing.
How much will my prescription cost?
Your cost is based on a 4-tier pricing system (beginning with Tier 0-Tier 3). Tier 0 represents the CarolinaCARE select products, whereby medications in this category are FREE of CHARGE to you, the member. Most often, if a medication is available in generic form, it will be the next least expensive option available to you, and is listed as a Tier 1 product. Plan-preferred medications make up the next category or Tier 2, while the brand name non-preferred comprises the fourth group of medications in Tier 3 . NOTE: If you purchase a brand name medication when a generic equivalent is available, you will pay 100% of the total cost for the brand name product.
What if the medication I am prescribed is not a generic or a plan preferred medication?
Your prescription benefit plan is structured to include several choices in each medication category. If your drug is not on the generic or plan preferred list, two things could happen:
- With your permission, the pharmacist will work with your doctor to select a similar medication that is on the generic or plan preferred list. It is important that you check the blank on your order form that gives the pharmacist permission to work with your doctor to select the most cost affordable medication for you.
- If you decide not to let the pharmacist work with your doctor to select another agent, you will be expected to pay the co-payment for the non-preferred medication.
Why are generic medications cheaper?
Pharmaceutical companies spend billions of dollars on the research and development to discover, market and patent new medications. While the drug company holds the patent to the brand name medication, prices are high to cover these expenses. Once the patent expires, the generic companies can produce the drug. Generic companies do not have to recoup research expenses. Many companies producing the same medication result in a competitive market that can keep prices down.
How do I know that generic medications are as good as the brand name?
Generic medications and generic manufacturers must undergo an approval process by the Food and Drug Administration (FDA). The highest rating for generic medications is the "AB" rated product. To receive an AB rating, the generic medication must pass the rigorous scrutiny of the FDA to ensure that it delivers the same amount of active drug to the patient's bloodstream in the same amount of time as the brand name medication. The generic must demonstrate the same potency over time as the brand name medication. The generic medication must meet all specifications set by the organizations that set standards for medications in the United States.
Just as it does with brand name medications, the FDA regulates generic makers' production sites, and blocks marketing of medications in substandard facilities. It is interesting to note that almost 80% of the generic drug production in the United States is done by brand name firms in modern manufacturing plants. The FDA publishes this statistic. The generic medications used in the employee health plan are selected very carefully to ensure that only the highest quality AB rated products are used.
How do I make sure that I get a generic medication if one is available?
There are two things that you can do:
- Encourage your doctor to prescribe generic medications for you.
- Check the blank on your order form that allows the CarolinaCARE pharmacist to work with your doctor to select the most cost-effective medication for you.
How can I make sure that I will get the most cost-effective medicine to treat my condition?
Your prescription plan was designed to include cost affordable and effective medications. To get the most cost effective medication, it is important to:
- Allow the substitution of a generic medication when possible. CarolinaCARE only selects the highest quality generics.
- If a generic medication is not available, check the blank on your order sheet that allows the CarolinaCARE pharmacist to work with your doctor to select the most cost affordable medication on your plan.
Why are my prescription copays higher than last year?
Each year, CHS reviews our benefits to ensure that we are providing a competitive benefits program. And each year the cost of healthcare – particularly prescription drugs – continues to rise. For instance, since 1993, spending for prescription drugs has increased 15% faster each year than spending for hospital and physician care. One of the reasons for increasing prescription drug costs is consumer demand for new and expensive drugs.
Copays for generic drugs, which are generally more cost-effective than brand-name drugs, will not increase. At the same time, in response to prescription drug cost increases, CHS will be increasing copays for Preferred Brand drugs and moving to coinsurance for copays for Non-Preferred Brand drugs.
What is co-insurance and how will it affect my copay?
Non-Preferred Brand drugs will have coinsurance instead of copays. With coinsurance, you pay a percentage of covered expenses. For 30-day supplies, you will pay 30% of the cost, but not less than $40 or more than $75. For 90-day mail order supplies, you will pay 30% of the cost, but not less than $100 or more than $150.
For example, if you get a 30-day supply of a Non-Preferred drug that has an actual cost of $150, you will pay $45 ($150 X 30% = $45).
For a list of the most common Preferred and Non-Preferred drugs, refer to the CarolinaCARE Medication Copay Guide.
Ordering Your Medications
How do I send new prescriptions to CarolinaCARE?
Complete details are available on the CarolinaCARE website through the link “Order a New Prescription”
Where can I find the history of my prescriptions filled through the CarolinaCARE/WHI network?
You may logon to the CarolinaCARE website and click on the link: “Review Prescription History” found under the WHI Services section of the homepage (remember that you must complete a separate registration and password on the WHI website to access this link). Due to HIPAA regulations, you will not be allowed to view the prescription history of your spouse or dependents who are 18 years of age and older. Likewise, only the CHS employee can manage the accounts of minor dependents. The employee must create the profile and password for each minor dependent on the WHI section only.
I am out of my prescription and need it immediately. What are my options?
For the first three prescription fills, you can visit your retail pharmacy of choice, including Rite-Aid, Walgreens, CVS, and the CHS-owned retail pharmacies. When appropriate, ask your physician to provide two (2) written prescriptions - one (30-day supply) to be filled immediately at a retail pharmacy, and a 90-day prescription to submit for mail delivery by CarolinaCARE.
What should I do if I cannot use a generic version of my medication?
CarolinaCARE buys the most reputable generic drugs. In fact, 80% of our generic drugs are manufactured by "brand name" pharmaceutical companies. If you choose the brand name version of your medication despite the availability of a suitable generic alternative, you will be expected to pay the full price of the brand name version.
When I ordered my prescriptions, I wanted them mailed to my home. Can I pick them up at a pharmacy location instead?
No. Orders submitted by mail, over the phone, or from the Web site immediately enter a processing queue at CarolinaCARE. It is not possible to change the mail order delivery method even within minutes of placing the order.
I have new prescriptions that don't yet need to be filled. Can I send them to CarolinaCARE to keep on file?
Yes. Send these prescriptions to CarolinaCARE along with a completed Prescription Order Form. The form allows you to clearly indicate which prescriptions should be filled and which prescriptions should be profiled (held) until further instructed. When directed.,we will add these prescriptions to your profile for future processing. Without a completed form, the prescriptions will be automatically processed and dispensed. If in doubt, please contact a CarolinaCARE representative before submitting your prescription.
NOTE: Schedule II prescriptions written for medications to treat ADHD in a 30-day quantity only may be filled at retail pharmacies on a continuous basis (i.e., methylphenidate, Concerta, etc).
I am a CHS employee, but I’m covered under my spouse’s insurance prescription plan (e.g. BlueCross BlueShield). Can CarolinaCARE process my prescription?
No. CarolinaCARE can process precriptions for employees and their eligible dependents covered by the CHS medical plan only. However, the CHS-owned retail pharmacies (i.e., locationas at Medical Center Plaza, Northcross, Matthews, and SouthPark) accept most third-party prescription cards and can likely process your prescription.
Payment Options
Can I use my flexible spending account debit card to order with CarolinaCARE?
Yes. Before you can charge prescriptions to your FSA debit card, you must activate the card and provide the account number to CarolinaCARE. You may update your method of payment at any time by logging in to the CarolinaCARE website at www.carolinacarerx.org. After you have logged in, go to "Update Your Profile" > "Manage Payment Method". If you do not have access to the website, call a CarolinaCARE customer service representative at 704-512-6800.
Can CarolinaCARE bill me for my medications?
No. A method of payment is required for all prescription orders prior to shipping from CarolinaCARE. Acceptable payment options include check, money order, credit/debit cards and payroll deduction. All financial information is secure and strictly confidential.
I sent in my Health Assessment Information, Method of Payment and Contact information forms. How can I make changes to this information?
You can manage your own method of payment and contact information by registering on the CarolinaCARE website, logging in, and then clicking Update Profile. Also, these three forms can be downloaded from the CarolinaCARE homepage or via Synapse, completed, and mailed or faxed to CarolinaCARE at any time (The employee fax line is 704-512-6802 or toll-free 866-307-9670).
ID Cards
Will I get a new ID card at the beginning of each new year?
No. Prescription ID cards are sent after your initial enrollment into the medical plan and to new employees as they opt for the benefit.
What should I do if I didn’t receive my ID prescription cards or I need extra prescription ID cards?
To resolve any issues regarding ID cards or the need for replacement cards, you can call CarolinaCARE Member Services at 704-512-6800. They will gladly handle the request for you.
What should I do if I have misplaced my CarolinaCARE ID card and need a prescription filled immediately?
To print a temporary CarolinaCARE/WHI prescription card, click Print Temporary ID Card at www.carolinacarerx.org. To order new, additional, or replacement ID cards, please call CarolinaCARE Member Services at 704-512-6800.
What if the information on the CarolinaCARE/WHI prescription ID card is incomplete or inaccurate?
The information appearing on your ID card is transmitted by CHS Human Resources directly to WHI. Therefore, to resolve any incomplete or inaccurate information on the card, please call CHS HR Benefits at 704-444-3004 option 3, and option 3. Do NOT call CarolinaCARE to update information appearing on the ID card.
CarolinaCARE Web Site
When I log in, why can't I see all of my covered dependents?
Before logging in, you must register. CarolinaCARE then enables the primary holder of coverage to manage information for him or herself and all covered dependents less than 18 years of age.
Currently, HIPAA regulations require dependents 18 years of age and older (including a spouse) to create and manage their own CarolinaCARE accounts.
What should I do if I can't log into the CarolinaCARE Web site?
The primary holder of coverage and all dependents 18 years of age and older must register before logging in to this Web site. Registration is a one-time process. When you register, you create your CarolinaCARE password. If you forget your CarolinaCARE password, contact Member Services to reset your password.
Remember: You may contact the CarolinaCARE Member Services representative at any time during regular business hours for assistance with or information about the website.