Capital Rx Pharmacy Plan FAQs: Updated Oct. 24, 2025
Q: Who do I contact if I have questions regarding my prescription drug coverage?
A: Please contact Capital Rx directly for all of your prescription drug questions at 866-957-7862. Customer Service Representatives are available 24/7.
Q: What pharmacy can I go to?
Capital Rx maintains a national network of more than 60,000 pharmacies, including national chains and most independent pharmacies (CVS, Walgreens, Kroger, etc.). To confirm if your pharmacy is in the network visit https://enrollment.cap-rx.com/?client=cookchildrens. Use the navigation menu and select your plan. Click ‘Start’. Enter your zip code and additional optional fields as appropriate. Your search results will display in-network pharmacies near you. Cook Children’s Employees can also now fill their prescriptions, including maintenance medications and specialty medications, at our own pharmacies! You can come into to any of the Cook Children’s pharmacy locations to pick up your prescriptions during operating hours.
Q: Why does the cost of my medication seem higher than usual?
There are various reasons as to why the cost of a medication is higher than usual. Some reasons may include:
- Medical plan deductible reset. If you are enrolled in the HSA medical plan, your annual deductible resets each year on October 1st. On the HSA plan, you will pay the full contracted price for medications until you meet your medical plan deductible; after the deductible is met, you will begin paying a copay or coinsurance, depending on the medication.
- Manufacturer copay card expiration or maximum discount amount reached. Manufacturer copay cards are a way to save on medications by offsetting the price to help you save on out-of-pocket costs. These cards typically cover medications that do not have a generic version. For questions on the status of your copay card, you will need to work with the manufacturer. If you had a copay card in place with CVS and changed pharmacies, you will need to add it back, as it would not have carried over with the transition to Capital Rx.
- Not all pharmacies charge the same price for the same medication; to check drug costs are pharmacies near you, visit https://enrollment.cap-rx.com/?client=cookchildrens
Q: How do I get a 90-day supply?
A: For participants with maintenance medications, our plan allows members to receive a 90-day supply as a single fill. You will need to obtain a 90-day prescription from your provider, and then get the medication filled at either a retail pharmacy or through Costco mail order. There are also cost savings when you fill a 90-day supply*: for generic medications, you will get a 3 month supply for the cost of a 2 month supply; for preferred and non-preferred brand medications, you will get a 3-month supply for the cost of a 2 ½ month supply.
*For those on the HSA medical plan, you will pay the full cost of the medication until the medical plan deductible is met; after the deductible is met, the cost savings will apply.
Q: I noticed that a medication that was previously on the $0 copay list is now requiring that I pay a coinsurance. Is this correct?
A: With the plan year that began 10/1/2025, there was an adjustment to the prior zero copay list. Most generic drugs will remain $0 copay, but coinsurance will apply for most brand name drugs. The current Preventive Drug list can be found here and on the Benefits page on CookNet. The list is separated out by no cost medications and those that will be available at the standard formulary coinsurance.
Q: How do I find out if my medication is on the formulary (list of approved drugs)?
A: To view the formulary specific to your prescription benefit plan, log into the member portal https://app.cap-rx.com/login. Use the navigation menu and select “Lookup Formulary” to learn more about medications that are covered.
Q: How do I get my specialty drugs?
A: Specialty medications can be dispensed at any of our 3 Cook Children’s Retail Pharmacy locations or Costco Specialty Pharmacy. Dodson Specialty Pharmacy and Costco Specialty can also dispense medications that may have special limitations.
- By utilizing Cook Children’s in-house specialty pharmacy, you will have access to the specialty pharmacy benefits. Refills can be ordered in person, by phone, or online at cookchildrens.org/mycookchildrens. Prescriptions can be picked up at the location listed below. If it seems your medication(s) are not available at Cook Children’s in-house pharmacy, please call one of our pharmacies for assistance.
- Dodson Specialty Pharmacy - 1500 Cooper St., Suite #1541, Fort Worth, TX 76104, Phone: 682-303-3900
- Hours: Mon-Fri 8 a.m. – 5:30 p.m.; Located on the first floor at Dodson, next to the Tech Zone
- Retail Pharmacy #1 - 801 7th Ave., Suite #1700, Fort Worth, TX 76104, Phone: 682-885-3142
- Hours: Sun-Sat 8 a.m. – 12 a.m.; Located on the first floor at FW Medical Center, across from ED
- Prosper Retail Pharmacy - 4200 W. University Drive, Prosper, TX 75078, Phone: 945-204-0350
- Hours: Mon-Fri 8 a.m. – 6 p.m., Sat-Sun 11 a.m. – 4 p.m.; Located on the first floor of Prosper Specialty Clinics
- Getting started with Costco Specialty: Please reach out to your prescriber and update your specialty pharmacy provider to Costco Specialty Pharmacy.
- Contact Costco Specialty Services to get started at 866-443-0060.
- Have your prescriber e-prescribe to Costco Specialty Pharmacy #1710, Zip Code 53717. Make sure your prescriber includes your contact information. If prior authorization is required, your prescriber may need to take extra steps to submit your prescription. To review more information related to prior authorizations, visit https://cap rx.com/members/ or call Capital Rx Customer Care.
- A representative from Costco Specialty Pharmacy will call you to obtain more information and schedule your first delivery. Additionally, you may call Capital Rx Customer Care to confirm receipt of the prescription from the prescriber. When calling, please follow the prompts for specialty pharmacy.
Q: I was told by my pharmacy that my drug is not covered. What do i do?
A: It’s always important to verify with Capital Rx on the coverage of your medication. If a medication is not included on the insurance plan’s formulary, you can still get the medication, but will have to pay the full cost of the medication. There may be alternative medications or generic options that are included on the formulary, and may be more affordable, so it is recommended that you consult with your healthcare provider to see if an alternative medication or generic medication is an option.
Another reason the pharmacy may tell you a drug is not covered could be because it requires prior authorization (PA), has a quantity limit (QL) or may be on a step therapy (ST) list. In this case, the drug is included on the formulary, but you first have to meet certain requirements. It will be best to contact Capital Rx at 866-957-7862 to discuss with a representative.
Q: If I previously had a prior authorization (PA) for my medication, do I need to request a new one?
Capital Rx has worked with CVS Caremark to receive a listing of all active PA records. This information has been loaded into your member profile with Capital Rx to ensure continuous access to your medications. If you have questions on your specific PA, please reach out to Capital Rx at 866-957-7862.
Q: What is a Prior Authorization (PA)
Approval may be required before your pharmacy benefit plan will cover certain drugs. This process ensures you receive a prescription that is safe and is the most cost effective. Once notified by the pharmacy, your doctor will work with Capital Rx to complete paperwork to submit a prior authorization.
Q: What is a Quantity Limit (QL)
There is a limit on the maximum dosage or quantity for certain medications that are covered per prescription, or within a specific time frame. If you require a dose or quantity beyond what the limit allows, please work with your doctor to submit a prior authorization for approval.
Q: What is Step Therapy (ST)
You may be required to try another medication (usually a generic) prior to starting the medication your doctor prescribed (usually a brand). If a medication you are prescribed has a step therapy program in place, please discuss your options with your doctor.