Massachusetts PDP Information 2017

PDP

Contract No./
Plan ID

Pharmacy Help Desk
Phone #

Prior Authorization
Phone #

Prior Authorization Form

 

Aetna

Plan Code:AE1
Rx Bin: 610502

Contract #: S5810

Plan ID #: 36

800-238-6279 800-414-2386 Obtain PA Form by calling PA Line

 

Blue Medicare Rx 

Plan Code: BL2
Rx Bin: 004336

Contract #: S2893

Plan ID #: 1, 3

800-364-6331 888-543-4917 Obtain PA Form by calling the PA line

 

CIGNA-HealthSpring

Plan Code:CIH
Rx Bin: 017010

Contract#: S5617

Plan ID #: 8, 247

888-625-5686 877-813-5595 Under "Customer Tools" click on "Part D - Customer Forms" then "Prior Authorization Forms " then select appropriate one.

 

Envision Rx Plus 

Plan Code:ENV
Rx Bin: 012312

Contract#: S7694

Plan ID #: 2

866-250-2005

Call Pharmacy
Help Desk

Go to “Formulary” then select appropriate form (PA, Step Therapy, Quantity Limits).

 

Express Scripts Medicare     

Plan Code: MD1
Rx Bin: 610014

Contract#: S5660

Plan ID #: 105, 206

800-922-1557 800-935-6103 Obtain PA Form by calling PA Line

 

First Health Part D 

Plan Code: FD1
Rx Bin: 610502

Contract #: S5768

Plan ID #: 126, 186

800-922-1557 800-551-2694 On top of page, click on “For Health Care Providers” then under “Prior Authorization & Exception Request Forms” select the appropriate one.

 

Humana PDP

Plan Code: HUV
Rx Bin: 015581

Contract #: S5884

Plan ID #: 2, 102, 149

800-865-8715 800-555-2546 Prior Authorization Form

Prescription Solutions
AARP

Plan Code: UTD
Rx Bin: 610097

Contract#: S0522, S5820, S5921

Plan ID#: 2 ,81, 348

800-788-7871 800-711-4555 Click on “Health Care Professionals” then under “Prior Authorizations” click on “Fax Forms” then select “Medicare Part D PA Forms” then select appropriate form.

Silver Script

Plan Code: SL1
Rx Bin: 004336

Contract #: S5601

Plan ID #: 4, 5

866-693-4620 866-235-5660 Click on “Documents” choose appropriate form under “Related Documents.”

Symphonix Rx

Plan Code: SL1 Rx Bin: 004336

Contract #: S0522

Plan ID #: 79

800-797-9791 800-711-7555 Obtain PA Form by calling the PA line

Tufts Health Plan

Plan Code: TU1
Rx Bin: 004336

Contract #: S0655

Plan ID #: 2

800-345-5413 888-413-2723 Obtain PA Form by calling the PA line

WellCare

Plan Code: WL2
Rx Bin: 004336

Contract#: S4802

Plan ID #: 76, 99

866-800-6111 Call Pharmacy Help Desk Obtain PA Form by calling Pharmacy Help Desk line