Submitted claims information must be accurate and complete. CVS Caremark’s claims adjudication system will allow zero dollar ($0) Usual and Customary (U&C) amounts on submitted claim transactions. This includes commercial, Medicaid and Medicare Part D claims.

Pursuant to the Provider Manual, "Usual and Customary" price means the lowest price Provider would charge to a particular customer if such customer were paying cash for an identical prescription on that particular day at that particular location. This price must include any applicable dispensing fee and/or level of effort. This price must include any applicable discounts offered to attract customers. Providers are required to submit accurate U&C prices for CVS Caremark claims.

Submitting all zero dollar U&C claims for acute and chronic medications will ensure that pharmacists can appropriately address any adherence issues, gaps in care, or drug interactions.

*Please see attached for more information.