Massachusetts PDP Information 2019

PDP

Contract No./
Plan ID

Pharmacy Help Desk
Phone #

Prior Authorization
Phone #

Prior Authorization Form

 

Aetna

Plan Code:AE1
Rx Bin: 610502

Contract #: S5768, S5810

Plan ID #: 36, 126, 276

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 Click on Documents then “Select State” then click on “View Documents”

 

CIGNA-HealthSpring

Plan Code:CIH
Rx Bin: 017010

Contract#: S5617

Plan ID #: 8, 247, 281

888-625-5686 877-813-5595 Click on “Health Care Providers” then under “Provider Resources” select “Drug Prior Authorization Request Forms”

 

Envision Rx Plus

Plan Code:ENV
Rx Bin: 012312

Contract#: S7694

Plan ID #: 2

866-250-2005

Call Pharmacy
Help Desk

Click on “Provider” enter Zip Code then continue. Click on “Coverage Determinations”

 

Express Scripts Medicare     

Plan Code: MD1
Rx Bin: 610014

Contract#: S5660

Plan ID #: 105, 206, 219

800-922-1557 800-935-6103 Obtain PA Form by calling PA line or use online portal (esrx.com/PA)

 

Humana PDP

Plan Code:HUV
Rx Bin: 015581

Contract #: S5884

Plan ID #: 2, 102, 149

800-865-8715 800-555-2546 Top of page, click on “Other Humana Sites” then “Providers” then go to Resources, click on “Prior Authorization for Pharmacy Drugs”

 

Mutual of Omaha

Plan Code:MON
Rx Bin: 610014

Contract #: S7126​

Plan ID #: 2, 35

 800-922-1557 844-374-7377 Obtain PA Form by calling PA line or use online portal (esrx.com/PA)

Prescription Solutions
AARP

Plan Code: UTD
Rx Bin: 610097

Contract#: S5820, S5921

Plan ID#: 2 , 348, 385

800-788-7871 800-711-4555 Click on “Health Care Professionals” then under “Prior Authorizations” click Submit a PA then “Digital & Fax Forms-Select” then “Medicare Part D forms-Select”

Silver Script

Plan Code: SL1
Rx Bin: 004336

Contract #: S5601

Plan ID #: 4, 5, 144

866-693-4620 866-235-5660 Click on “Documents” select appropriate form under “Member Resources"

 

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, 137

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