Beginning January 1, 2026, Caremark will replace Express Scripts as the pharmacy benefits manager for the State Health Plan. Caremark serves more than 88 million people. You will receive information from Caremark over the next few months, and we encourage you to review the information carefully. While we expect this to be a smooth transition, call the phone number in the materials if you have questions.
Identification cards
All subscribers will receive a new prescription benefits ID card before December 31, 2025. Covered dependents will use the card issued in the subscriber’s name. The card will include important information your pharmacist will need to process your claim. Beginning January 1, provide your network pharmacy with the new card so they can update your records.
If you are a Medicare-eligible retiree, survivor or COBRA subscriber, you will also receive a new ID card from Caremark. Federal regulations require PEBA to provide Medicare-primary individuals with a separate prescription drug card.
Frequently asked questions
The following frequently asked questions might be helpful to you. We will update these FAQs as more details become available through the implementation process.
PEBA contracts with several third-party administrators to process claims and administer benefits. Public contracts are awarded in accordance with South Carolina's procurement laws. PEBA’s processes and procedures are defined by rules designed to prevent fraud, collusion or unjust favoritism in awarding public contracts; to ensure everyone has an equal opportunity to compete for public contracts; to secure for the public the benefits of full and open competition; and to provide for efficiency and increased economy in the expenditure of public funds.
PEBA issued a request for proposals for the pharmacy benefits manager contract beginning January 1, 2026. After careful evaluation of responsive vendors, Caremark was deemed most advantageous to PEBA and was awarded the contract.
Members will receive a welcome kit before January 1, 2026, that will guide you to a personalized digital experience. Simply scan the QR code on the letter or visit Caremark.com to get started. Once online, you can:
- Register your account;
- Download your prescription ID card; and
- Explore your plan details.
We do not anticipate network disruptions for our members. Caremark’s retail pharmacy network is national in scope and comprised of more than 64,000 pharmacies, including major chains, as well as regional and independent pharmacies. Currently, 98% of local pharmacies participate in the Caremark network. While rare, there might be changes to your retail pharmacy (e.g., pharmacy closures or pharmacy does not currently participate in the network). Caremark will contact pharmacies that do not participate to request they join the Caremark network.
Caremark has an online tool for members to find a network pharmacy at http://www.caremarkrxplaninfo.com/scpeba.
PEBA determines the copayments for prescription drugs, and there will be no changes to copayments in 2026. Below are copayments for 30-day and 90-day supplies at a network pharmacy:
- Tier 1: $13/$32
- Tier 2: $46/$115
- Tier 3: $77/$192
Most prescriptions will remain in the same category. Caremark has an online tool for members to use to price a medication at http://www.caremarkrxplaninfo.com/scpeba.
The PBM determines the formulary, or list of covered drugs. The PBM’s committee of independent physicians and pharmacists continually reviews and compares the medications on the formulary. As a result, some safe and effective drugs become preferred, and others might become non-preferred. Formulary decisions involve many factors, including clinical safety, drug effectiveness, product ingredient cost and member disruption.
PEBA will use Caremark’s Advanced Control Specialty Formulary; however, the State Health Plan might not cover certain medications regardless of their appearance on the document. Members will be able to create Caremark accounts in mid-December. After they create an account, they can search for a network pharmacy and price medications covered by the Plan.
The formulary for Medicare-primary members is based on the Centers for Medicare and Medicaid Services guidelines.
You do not need to get a new prescription. Simply let your pharmacy know you have new insurance information and show them your new ID card from Caremark so the pharmacy can process your refills after January 1, 2026.
Generally, open prior authorizations will transfer to Caremark before January 1, 2026. When an existing prior authorization expires after January 1, your doctor must contact Caremark to initiate a new prior authorization. Prior authorizations for controlled substances will not transfer to Caremark, and your doctor must contact Caremark to initiate a new prior authorization after January 1.
Caremark will receive a list of all open prescriptions on file with Express Scripts Pharmacy. While we expect this to be a smooth transition, if you are due for a refill at the end of December or first week of January, PEBA recommends you contact Express Scripts no later than the first week of December to request a refill so it can be shipped before January 1. All refills due to ship on or after January 1, 2026, will come from Caremark’s mail order pharmacy. Note some prescriptions, such as controlled substances or expired refills, might not automatically transfer and will require a new prescription from your doctor.
Caremark will receive a list of all open specialty prescriptions on file with Accredo for State Health Plan primary members. While we expect this to be a smooth transition, if you are due for a refill at the end of December or first week of January, PEBA recommends you contact Express Scripts no later than the first week of December to request a refill so it can be shipped before January 1. All refills due to ship on or after January 1, 2026, will come from Caremark’s specialty pharmacy.
Any claim filed on or after January 1, 2026, using the Express Scripts prescription information will be denied. Be sure to tell your pharmacy you have new coverage information and show them your new ID card from Caremark so the pharmacy can update your information and fill your prescription.
State Health Plan Medicare-primary retirees and their covered Medicare-eligible spouses and/or children will have a new Medicare prescription drug program through the State Health Plan, known as SilverScript. SilverScript is Caremark's Medicare Part D contractor. Your enrollment in SilverScript will automatically cancel your enrollment in Express Scripts Medicare, if you participate. There will be no interruption in your prescription drug coverage. PEBA will automatically enroll you in SilverScript, so you do not need to take any action to enroll in a Medicare Part D plan. In the coming months, you might receive a termination letter from Express Scripts, as well as enrollment letters from SilverScript. Read them carefully as you may need to provide additional information.
Yes. No-Pay Copay will still be available to eligible members. By completing certain activities in Personify Health (Personify) each year and earning at least two credits, members can receive certain generic drugs related to their condition the following year at no or lower cost. Covered conditions include:
- High blood pressure and high cholesterol.
- Cardiovascular disease, congestive heart failure and coronary artery disease.
- Diabetes.
Eligible generic prescriptions and diabetic supplies beginning January 1, 2026
- Antihypertensive drug list
- Cholesterol-lowering drug list
- Diabetes drug list and testing supplies
- Diabetes drug list and testing supplies for $13 generic copayment
Learn more about No-Pay Copay on our PEBA Perks webpage.