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Medicare Part D
Prescription Drug Coverage 2027
CVS Caremark Medicare Part D 2027: What Caremark Does and How to Get Coverage
Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 31, 2026
CVS Caremark does not sell Medicare Part D plans in 2027; it is a pharmacy benefit manager that processes claims, runs mail-order and specialty pharmacy services, and manages pharmacy networks for drug plans. To get Part D coverage, you enroll in a plan from an insurer, and that plan may use Caremark behind the scenes.
2027 by the Numbers
0
2027 standalone Part D filings under the Caremark name; coverage comes from insurers (our count of CMS 2027 plan filings)
15
sponsors offering 2027 standalone Part D plans (our count of CMS 2027 plan filings)
$2,400
2027 out-of-pocket cap, the same whether you fill by mail or at a store (CMS)
Many people find the Caremark name on a prescription card or a mail-order box and assume it is their insurance company. It usually is not. Caremark is the middle layer between your drug plan and the pharmacy, and knowing that changes where you go for help and how you shop for 2027 coverage.
This page explains Caremark’s job, which Medicare members are likely to deal with it, how to actually get Part D coverage, and when mail order saves money. It is part of our Medicare Part D plans 2027 series.
Key Takeaways
- Caremark is CVS Health’s pharmacy benefit manager (PBM); it works for drug plans, not as one.
- Aetna’s SilverScript plan uses CVS Caremark Mail Service Pharmacy and CVS Specialty, per its plan documents.
- Many employer and union retiree drug plans also run their pharmacy benefits through Caremark.
- Your premium, deductible, tiers and covered drugs are set by your plan, not by Caremark.
- Mail order only saves money when your plan charges less for a 90-day supply; coinsurance works the same either way.
What a Pharmacy Benefit Manager Actually Does
A Part D plan sponsor, such as an insurer, is legally responsible for your coverage. Most sponsors hire a pharmacy benefit manager to do the day-to-day pharmacy work. CVS Caremark is one of the largest PBMs in the country and is owned by CVS Health.
What your Part D plan decides
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Monthly premium and deductible
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Which drugs are on the formulary and their tiers
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Prior authorization and appeal decisions
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Your Annual Notice of Change
What a PBM like Caremark often handles
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Processing the claim when you fill a prescription
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Building and paying the pharmacy network
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Running mail-order and specialty pharmacies
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Negotiating drug maker rebates for the plan
Which Medicare Members Deal With Caremark
| Your situation | Where Caremark may show up |
|---|---|
| Aetna SilverScript Choice member | Mail service and specialty fills through CVS Caremark and CVS Specialty, per SilverScript plan documents |
| Aetna Medicare Advantage member | Aetna plans are part of CVS Health, so pharmacy services may run through Caremark; check your card |
| Retiree with an employer or union drug plan | Many group Medicare drug plans use Caremark; your former employer’s plan decides |
| Member of another insurer’s plan | That plan may use a different PBM, such as Express Scripts, OptumRx or Prime Therapeutics |
PBM contracts change. The name and help line printed on your 2027 member card are the best guide.
Quick check: Turn your drug plan card over. If it lists Caremark for pharmacist help or mail order, Caremark handles your pharmacy claims, but your plan is still the insurer named on the front.
How to Get Part D Coverage if You Want Caremark Services
1
Choose a plan, not a PBM. You enroll with an insurer during open enrollment, October 15 to December 7, 2026, for coverage starting January 1, 2027.
2
Start with your drug list. Enter your exact drugs and doses to see 2027 cost estimates for plans in your ZIP code.
3
Check the mail-order option. If you want home delivery, see whether the plan offers it and what a 90-day supply costs.
4
Confirm your pharmacy. Make sure the store you use is in the plan’s 2027 network.
5
Retirees: ask your former employer first. Dropping a group plan can mean losing it for good, so check before enrolling elsewhere.
Aetna’s standalone plan is the CVS Health option; see SilverScript Medicare Part D 2027 for its design and Aetna Medicare Part D plans 2027 for where it is sold.
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Mail Order vs Retail: When 90 Days Saves Money
Mail-order savings come from how your plan prices a 90-day supply, not from Caremark itself. Here is our own illustration using made-up copays, with the 2027 rules applied.
| Example drug cost-sharing | Retail, 30-day fills (12 a year) | Mail, 90-day fills (4 a year) | Difference |
|---|---|---|---|
| $10 copay; 90-day = 2 copays | $120 | $80 | Mail saves $40 |
| $10 copay; 90-day = 3 copays | $120 | $120 | No savings |
| 25% coinsurance on a $200 drug, after the deductible | $50 a month | $150 a quarter | Same cost |
| Spending already past the $2,400 cap | $0 | $0 | Same cost |
Illustrative only. Plans set their own 2027 copays for 30-day and 90-day supplies, and some charge the same everywhere.
Where mail order really helps: Steady maintenance drugs, fewer trips, and a 90-day stock on hand. Keep a few days’ buffer, since shipments can take a week or more.
Specialty Drugs and CVS Specialty
Specialty drugs, such as many cancer, multiple sclerosis or rheumatoid arthritis treatments, often need special handling. Plans that use Caremark may send these prescriptions to CVS Specialty, which ships them and offers pharmacist support.
Before your first specialty fill in 2027
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Ask whether your plan requires a specific specialty pharmacy
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Get prior authorization done before the first fill
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Expect 25% coinsurance or a specialty tier charge until you reach the $2,400 cap
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Consider the Medicare Prescription Payment Plan if a January bill would be large
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Who to Call About What
| Problem | Start with |
|---|---|
| Drug denied or needs prior authorization | Your Part D plan, which makes coverage decisions and handles appeals |
| Mail-order shipment late or wrong | The mail-order pharmacy on your card |
| Premium bill or enrollment question | Your Part D plan |
| Want to change plans | Medicare or the new plan, during an enrollment period |
Appeals in Part D are decided by your plan, even when a PBM processes the claim.
Our Medicare Part D formulary 2027 page explains exceptions and appeals.
What 2027 Changes Mean at the Pharmacy Counter
Rules every Part D claim follows in 2027, whoever processes it
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Deductible of up to $700, set by your plan
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Out-of-pocket cap of $2,400, then $0 for covered drugs
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Covered insulin capped at $35 for a month’s supply
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Medicare-negotiated prices for 25 drugs, including 15 new ones such as Ozempic from January 1, 2027
Negotiated prices lower what the plan pays and, when you owe coinsurance, what you pay. The PBM’s job is to make sure pharmacies are paid correctly under those prices.
The Bottom Line
The Bottom Line
CVS Caremark is a service company for drug plans, not a plan you can join. Pick a 2027 Part D plan based on your drugs, pharmacy and total yearly cost, then use whatever mail-order or specialty service that plan offers. If home delivery matters to you, compare 90-day costs before you enroll.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options.
Frequently Asked Questions
➤ Can I enroll in a CVS Caremark Medicare Part D plan?
No. Caremark does not sell Part D plans. You enroll in a plan from an insurer, and that plan may use Caremark for pharmacy services.
➤ Is CVS Caremark the same as SilverScript?
No. SilverScript is Aetna’s drug plan, and Caremark is the CVS Health pharmacy benefit manager. Both belong to CVS Health, and SilverScript uses Caremark mail service.
➤ Does Caremark decide whether my Medicare drug is covered?
Your Part D plan makes coverage decisions and handles appeals. Caremark may process the claim, but the formulary and exceptions belong to the plan.
➤ Do I have to use CVS pharmacies if my plan uses Caremark?
Not necessarily. Caremark networks usually include many chains and independents. Check your plan’s 2027 pharmacy directory.
➤ Is Caremark mail order cheaper for Medicare members?
Only if your plan prices 90-day mail supplies lower. With coinsurance, or once you pass the $2,400 cap, the cost is generally the same.
➤ I am a retiree and my card says Caremark. Should I shop for a new Part D plan?
Check with your former employer or union first. Leaving a group drug plan can end your retiree benefits, and your group plan may be worth keeping.
➤ Does Caremark handle the Medicare negotiated prices for drugs like Ozempic in 2027?
Plans and their PBMs apply the negotiated prices that start January 1, 2027. You should see them reflected in what you pay if you owe coinsurance.
➤ Who do I call if a Caremark mail-order shipment is late?
Contact the mail-order pharmacy listed on your plan card. For a coverage problem, contact your Part D plan instead.
ZRN Health & Financial Services, LLC, a Texas limited liability company.
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