PEBA awarded the contract for pharmacy benefits management services to Caremark. Beginning January 1, 2026, Caremark will replace Express Scripts as the pharmacy benefits manager for the State Health Plan. The new contract aims to address rising costs of prescriptions, while maintaining access for members. The initial contract term is two years with three one-year renewal options, for a maximum contract term of five years.

How will this change impact State Health Plan members?

The contract with Caremark will provide prescription drug benefits to more than 541,000 members. 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 pharmacists will need to process claims. Beginning January 1, members must provide their network pharmacy with the new card so the pharmacy can update their records.

Members who are eligible for Medicare will also receive a new ID card from Caremark. Federal regulations require PEBA to provide Medicare-primary individuals with a separate prescription drug card.

To ensure you receive your new ID card, log in to MyBenefits to review and update your address on file with PEBA before Monday, September 15, 2025.

PEBA has a webpage dedicated to the transition to Caremark. During the implementation process, we will provide FAQs on that page. We encourage members to check this page often as further details become available.

Why is PEBA transitioning to a new PBM?

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.