2016 Medicare Part D Preferred Network Status - PBA Health · PDF fileMedicare Part D...

2016 Medicare Part D

Preferred Network Status

Confidential

PBM Company Plan

Is TriNet Contracted with

this plan?Y/N

Does this plan offer Preferred Networks(i.e. patients are only

allowed to go to certain pharmacies/ PSAOs that

participate)?Y/N

If Preferred, are TriNet Pharmacies listed as

Preferred?Y/N

What Chains/ PSAOs are in these preferred

networks?

CVS/Caremark (Aetna) Aetna Medicare Aetna Medicare Rx Saver (PDP) Y Y N

AccessHealth, Epic, LeaderNet

(MCC0), Third Party Network,

Brookshire Bros, Albertsons,

Costco, Giant Eagle, Harris Teeter,

HEB, Kroger, Meijers, Rowdys,

Safeway, Sav-Mor, ShopCo, Thrifty

White, Wal-Mart, Walgreens

CVS/Caremark (Aetna) First Health Part D First Health Part D Premier Plus (PDP) Y Y N








CVS/Caremark (Aetna) First Health Part D First Health Part D Value Plus (PDP) Y Y N








Catamaran Cigna-HealthSpring Rx Cigna-HealthSpring Rx Secure (PDP) Y Y N

LeaderNet, Walgreens, Wal-Mart,

HyVee, Brookshire Brothers,

Kroger, Kmart, Price Chopper

Catamaran Cigna-HealthSpring RxCigna-HealthSpring Rx Secure-Extra

(PDP)Y Y N

LeaderNet, Walgreens, Wal-Mart,

HyVee, Brookshire Brothers,

Kroger, Kmart, Price Chopper

Catamaran/ Regence Asuris Northwest Health Asuris Medicare Script Basic (PDP) Y N

11/18/2015 1 of 13 Chart subject to change



Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Catamaran/ Regence Asuris Northwest Health Asuris Medicare Script Enhanced (PDP) Y N

Catamaran/ Regence Regence BlueCross BlueShield of Utah Regence Medicare Script Basic (PDP) Y N

Catamaran/ Regence Regence BlueCross BlueShield of UtahRegence Medicare Script Enhanced

(PDP)Y N

Catamaran/ Regence Regence BlueShield of Idaho Regence Medicare Script Basic (PDP) Y N

Catamaran/ Regence Regence BlueShield of IdahoRegence Medicare Script Enhanced

(PDP)Y N

CVS/Caremark Avalon Insurance Company SecureRx - Option 1 (PDP) Y Y NCVS, Wal-Mart, Walgreens, Rite-

Aid, Target

CVS/Caremark Avalon Insurance Company SecureRx - Option 3 (PDP) Y Y NCVS, Wal-Mart, Walgreens, Rite-

Aid, Target

CVS/ CaremarkBlue Cross and Blue Shield of

MassachusettsBlue MedicareRx Premier (PDP) Y Y N Wal-Mart, Target, CVS

CVS/ CaremarkBlue Cross and Blue Shield of

MassachusettsBlue MedicareRx Value Plus (PDP) Y Y N Wal-Mart, Target, CVS




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

CVS/ Caremark Blue Cross and Blue Shield of Minnesota MedicareBlue Rx Premier (PDP) Y Y N

PPOK, CVS/pharmacy, Hy-Vee,

Shopko, Target, Wal-Mart, White

Drug

CVS/ Caremark Blue Cross and Blue Shield of Minnesota MedicareBlue Rx Standard (PDP) Y Y N



Drug

CVS/ Caremark Blue Cross and Blue Shield of Montana MedicareBlue Rx Premier (PDP) Y Y N



Drug

CVS/ Caremark Blue Cross and Blue Shield of Montana MedicareBlue Rx Standard (PDP) Y Y N



Drug

CVS/ Caremark Blue Cross and Blue Shield of Nebraska MedicareBlue Rx Premier (PDP) Y Y N



Drug

CVS/ Caremark Blue Cross and Blue Shield of Nebraska MedicareBlue Rx Standard (PDP) Y Y N



Drug

CVS/ Caremark Blue Cross and Blue Shield of Vermont Blue MedicareRx Premier (PDP) Y Y N PPOK, Wal-Mart, Target, CVS

CVS/ Caremark Blue Cross and Blue Shield of Vermont Blue MedicareRx Value Plus (PDP) Y Y N PPOK, Wal-Mart, Target, CVS

CVS/ Caremark Blue Cross Blue Shield of North Dakota MedicareBlue Rx Premier (PDP) Y Y N



Drug




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

CVS/ Caremark Blue Cross Blue Shield of North Dakota MedicareBlue Rx Standard (PDP) Y Y N



Drug

CVS/ Caremark Blue Cross Blue Shield of Wyoming MedicareBlue Rx Premier (PDP) Y Y N



Drug

CVS/ Caremark Blue Cross Blue Shield of Wyoming MedicareBlue Rx Standard (PDP) Y Y N



Drug

CVS/ Caremark SilverScript SilverScript Choice (PDP) Y N

CVS/ Caremark SilverScript SilverScript Plus (PDP) Y Y Y

TriNet, PPOK, United, LeaderNet,

Wal-Mart, Target, CVS, HyVee,

Price Chopper, Walgreens, Hy-Vee

CVS/ CaremarkWellmark Blue Cross and Blue Shield of

IowaMedicareBlue Rx Premier (PDP) Y Y N



Drug

CVS/ CaremarkWellmark Blue Cross and Blue Shield of

IowaMedicareBlue Rx Standard (PDP) Y Y N



Drug

CVS/ CaremarkWellmark Blue Cross Blue Shield of South

DakotaMedicareBlue Rx Premier (PDP) Y Y N



Drug

CVS/ CaremarkWellmark Blue Cross Blue Shield of South

DakotaMedicareBlue Rx Standard (PDP) Y Y N



Drug




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

CVS/Caremark United American Insurance Company United American - Enhanced (PDP) Sanctioned Y LeaderNet

CVS/Caremark United American Insurance Company United American - Essential (PDP) Sanctioned Y LeaderNet

CVS/Caremark United American Insurance Company United American - Select (PDP) Sanctioned Y LeaderNet

CVS/ Caremark WellCare WellCare Classic (PDP) Y N; dropped the option for 2016

CVS/Caremark WellCare WellCare Simple (PDP) Y N; dropped the option for 2016

CVS/Caremark WellCare WellCare Extra (PDP) Y N; dropped the option for 2016

EnvisionRx Options EnvisionRx Plus EnvisionRxPlus Silver (PDP) Y Y YTriNet, Price Chopper, Walgreens,

Wal-Mart

EnvisionRx Options EnvisionRx Plus EnvisionRxPlus Clear Choice (PDP) Y Y YTriNet, Price Chopper, Walgreens,

Wal-Mart

Express Scripts Anthem Blue Cross and Blue Shield Anthem Blue MedicareRx Plus (PDP) Y Y N Target, CVS, Wal-Mart




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Express Scripts Anthem Blue Cross and Blue Shield Anthem Blue MedicareRx Premier (PDP) Y Y N Target, CVS, Wal-Mart

Express Scripts Anthem Blue Cross and Blue ShieldAnthem Blue MedicareRx Standard

(PDP)Y Y N Target, CVS, Wal-Mart

Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Premier (PDP) Y Y N Target, CVS, Wal-Mart

Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Value Plus (PDP) Y Y N Target, CVS, Wal-Mart

Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Plus (PDP) Y Y N Target, CVS, Wal-Mart

Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Value (PDP) Y Y N Target, CVS, Wal-Mart

Express ScriptsAnthem Blue Cross Life and Health

Insurance Co

Anthem Blue Cross MedicareRx Gold

(PDP)Y United, Target, CVS


Insurance Co

Anthem Blue Cross MedicareRx Plus

(PDP)Y United, Target, CVS


Insurance Co

Anthem Blue Cross MedicareRx

Standard (PDP)Y United, Target, CVS




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Express Scripts Blue Cross Blue Shield of Georgia BCBSGa Blue MedicareRx Plus (PDP) Y Y N CVS, Kroger, Wal-Mart

Express Scripts Blue Cross Blue Shield of Georgia BCBSGa Blue MedicareRx Premier (PDP) Y Y N CVS, Kroger, Wal-Mart

Prime Therapeutics Blue Cross Blue Shield of GeorgiaBCBSGa Blue MedicareRx Standard

(PDP)Y Y N CVS, Kroger, Wal-Mart

Express Scripts Blue Cross Blue Shield of Michigan Prescription Blue Option A (PDP) Y Y NUnited, Walgreens, RiteAid,

Kroger, Costco

Express Scripts Blue Cross Blue Shield of Michigan Prescription Blue Option B (PDP) Y Y NUnited, Walgreens, RiteAid,

Kroger, Costco

Express Scripts Blue MedicareRx Blue MedicareRx Plus (PDP) Y Y N

Express Scripts Blue MedicareRx Blue MedicareRx Premier (PDP) Y Y N

Express Scripts Blue MedicareRx Blue MedicareRx Value (PDP) Y Y N

Express Scripts EMI Health Educators Rx Advantage (PDP) Y N




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Express Scripts EMI Health Educators Rx Basic (PDP) Y N

Express Scripts Express Scripts Medicare Express Scripts Medicare - Choice (PDP) Y Y YTriNet, PPOK, United, LeaderNet,

Walgreens

Express Scripts Express Scripts Medicare Express Scripts Medicare - Value (PDP) Y Y YTriNet, PPOK, United, LeaderNet,

Walgreens

Express Scripts HealthNow New York Inc. SmartSaver Rx PDP Value (PDP) Y

Express Scripts Highmark Health Insurance Company Blue Rx PDP Complete (PDP) Y N

Express Scripts Highmark Health Insurance Company Blue Rx PDP Plus (PDP) Y N

Express Scripts WPS Health Insurance WPS MedicareRx Plan 1 (PDP) Y N

Express Scripts WPS Health Insurance WPS MedicareRx Plan 2 (PDP) Y N

MagellanRx Magellan Rx Medicare Magellan Rx Medicare Basic (PDP) Y Y Y TriNet, LeaderNet




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Medimpact QualChoice Advantage SilverSelect Rx (PDP) Y N/A

Medimpact Senior Care PlusSenior Care Plus: Medicare Rx Choice

(PDP)Y

Medimpact Senior Care PlusSenior Care Plus: Medicare Rx Standard

(PDP)Y

Medimpact Stonebridge Life Insurance Company Transamerica MedicareRx Classic (PDP) Y Y N Walgreens

Meridian Advantage-Plus Meridian Advantage-Plus Meridian (PDP) Y N

Prime Therapeutics Arkansas Blue Cross and Blue Shield AR Blue Cross - Medi-Pak Rx Basic (PDP) Y Y NPPOK, LeaderNet, GNPPN, Epic,

Walgreens, Wal-Mart

Prime Therapeutics Arkansas Blue Cross and Blue ShieldAR Blue Cross - Medi-Pak Rx Premier

(PDP)Y N

PPOK, LeaderNet, GNPPN, Epic,

Walgreens, Wal-Mart

Prime Therapeutics Blue Cross and Blue Shield of Alabama BlueRx Option I (PDP) Y Y N

PPOK, LeaderNet, Walgreens,

Medicine Shoppe, Wal-Mart, Rite

Aid, Publix

Prime Therapeutics Blue Cross and Blue Shield of Alabama BlueRx Option II (PDP) Y Y N

PPOK, LeaderNet, Walgreens,

Medicine Shoppe, Wal-Mart, Rite

Aid, Publix




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Prime Therapeutics Blue Cross and Blue Shield of Arizona Blue MedicareRx Enhanced (PDP) Y Y NPPOK, Safeway, CVS, Frys, Target,

Wal-Mart

Prime Therapeutics Blue Cross and Blue Shield of Arizona Blue MedicareRx Value (PDP) Y Y NPPOK, Safeway, CVS, Frys, Target,

Wal-Mart

Prime TherapeuticsBlue Cross and Blue Shield of North

CarolinaBlue Medicare Rx Enhanced (PDP) Y Y N

PPOK, Epic, Walgreens, Wal-Mart,

CVS, RiteAid

Prime TherapeuticsBlue Cross and Blue Shield of North

CarolinaBlue Medicare Rx Standard (PDP) Y Y N

PPOK, Epic, Walgreens, Wal-Mart,

CVS, RiteAid

Prime Therapeutics Blue Cross Blue Shield of South Carolina BlueCross Rx Plus (PDP) Y Y NLeaderNet, Bi-Lo, Rite Aid, Sam's,

Wal-Mart, Walgreens

Prime Therapeutics Blue Cross Blue Shield of South Carolina BlueCross Rx Value (PDP) Y Y NPPOK, LeaderNet, Bi-Lo, Rite Aid,

Sam's, Wal-Mart, Walgreens

Prime Therapeutics Florida Blue BlueMedicare Rx-Option 1 (PDP) Y Y NCVS, Publix, Target, Navarro,

Walgreens

Prime Therapeutics Florida Blue BlueMedicare Rx-Option 2 (PDP) Y Y NCVS, Publix, Target, Navarro,

Walgreens

Prime Therapeutics HISC - Blue Cross Blue Shield of Illinois Blue Cross MedicareRx Basic (PDP) Y Y NPPOK, Sam's, CVS, Jewel-Osco,

Walgreens, Wal-Mart




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Prime Therapeutics HISC - Blue Cross Blue Shield of Illinois Blue Cross MedicareRx Plus (PDP) Y Y NPPOK, Sam's, CVS, Jewel-Osco,

Walgreens, Wal-Mart

Prime Therapeutics HISC - Blue Cross Blue Shield of Illinois Blue Cross MedicareRx Value (PDP) Y Y NPPOK, Sam's, CVS, Jewel-Osco,

Walgreens, Wal-Mart

Prime TherapeuticsHISC - Blue Cross Blue Shield of New

MexicoBlue Cross MedicareRx Basic (PDP) Y Y N

Sam's, CVS, Allbertsons,

Walgreens, Wal-Mart


MexicoBlue Cross MedicareRx Plus (PDP) Y Y N


Walgreens, Wal-Mart


MexicoBlue Cross MedicareRx Value (PDP) Y Y N


Walgreens, Wal-Mart

Prime Therapeutics HISC - Blue Cross Blue Shield of Oklahoma Blue Cross MedicareRx Basic (PDP) Y Y NPPOK, CVS, Walgreens, Wal-Mart,

AccessHealht, PPOK

Prime Therapeutics HISC - Blue Cross Blue Shield of Oklahoma Blue Cross MedicareRx Plus (PDP) Y Y NPPOK, CVS, Walgreens, Wal-Mart,

AccessHealht, PPOK

Prime Therapeutics HISC - Blue Cross Blue Shield of Oklahoma Blue Cross MedicareRx Value (PDP) Y Y NPPOK, CVS, Walgreens, Wal-Mart,

AccessHealht, PPOK

Prime Therapeutics HISC - Blue Cross Blue Shield of Texas Blue Cross MedicareRx Basic (PDP) Y Y NPPOK, CVS, HEB, Sam's, Walgreens,

Wal-Mart, AccessHealth




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

Prime Therapeutics HISC - Blue Cross Blue Shield of Texas Blue Cross MedicareRx Plus (PDP) Y Y NPPOK, CVS, HEB, Sam's, Walgreens,


Prime Therapeutics HISC - Blue Cross Blue Shield of Texas Blue Cross MedicareRx Value (PDP) Y Y NPPOK, CVS, HEB, Sam's, Walgreens,


Prime TherapeuticsHorizon Blue Cross Blue Shield of New

Jersey

Horizon Medicare Blue Rx Enhanced

(PDP)Y Y N

LeaderNet, CVS, Rite Aid,

Walgreens, Wal-Mart

Prime TherapeuticsHorizon Blue Cross Blue Shield of New

Jersey

Horizon Medicare Blue Rx Standard

(PDP)Y Y N

LeaderNet, CVS, Rite Aid,

Walgreens, Wal-Mart

Prime Therapeutics UTIC Insurance Company BlueRx Option I (PDP) Y Y NPPOK, LeaderNet, CVS, Rite Aid,

Walgreens, Wal-Mart

Prime Therapeutics UTIC Insurance Company BlueRx Option II (PDP) Y Y NPPOK, LeaderNet, CVS, Rite Aid,

Walgreens, Wal-Mart




Confidential

PBM Company Plan


this plan?Y/N



participate)?Y/N


Preferred?Y/N


networks?

BS of California Blue Shield of California Blue Shield Medicare Basic Plan (PDP) N

BS of CaliforniaBlue Shield of California

Blue Shield Medicare Enhanced Plan

(PDP) N

Humana Humana Insurance Company Humana Enhanced (PDP) N Y

Humana Humana Insurance Company Humana Preferred Rx Plan (PDP) N Y

Humana Humana Insurance Company Humana Walmart Rx Plan (PDP) N Y

HumanaHumana Insurance Company of New York

Humana Enhanced (PDP) N Y


Humana Preferred Rx Plan (PDP) N Y


Humana Walmart Rx Plan (PDP) N Y

Humana Humana Insurance of Puerto Rico, Inc. Humana Enhanced (PDP) N Y

Humana Humana Insurance of Puerto Rico, Inc. Humana Preferred Rx Plan (PDP) N Y

OptumRx Symphonix Health Symphonix PrimeSaver Rx (PDP) N Y

OptumRx Symphonix Health Symphonix Value Rx (PDP) N Y

OptumRx UnitedHealthcare AARP MedicareRx Preferred (PDP) N Y

OptumRx UnitedHealthcare AARP MedicareRx Saver Plus (PDP) N Y


2016 Medicare Part D Preferred Network Status - PBA Health · PDF fileMedicare Part D...

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