Texas 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 #: 56, 145, 293

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

Blue Medicare Rx Basic

Plan Code:BBS
Rx Bin: 011552

Contract #: S5715

Plan ID #: 014

888-229-2812 800-693-6651 Under “Sign in” click Continue without Sign in – Health Plan=BCBS Texas- Medicare Part D member=yes- Health Plan type=pick one- Continue then click on Forms then choose appropriate one

Blue Medicare Rx Value

Plan Code: BVA

Rx Bin: 011552

Contract #: S5715

Plan ID#: 005

888-229-2812 800-693-6651 Under “Sign in” click Continue without Sign in – Health Plan=BCBS Texas- Medicare Part D member=yes- Health Plan type=pick one- Continue then click on Forms then choose appropriate one

Blue Medicare Rx Plus

Plan Code: BLM
Rx Bin: 011552

Contract #: S5715

Plan ID #: 006

888-229-2812 800-693-6651 Under “Sign in” click Continue without Sign in – Health Plan=BCBS Texas- Medicare Part D member=yes- Health Plan type=pick one- Continue then click on Forms then choose appropriate one

CIGNA-HealthSpring

Plan Code: CIH
Rx Bin: 017010

Contract #: S5617

Plan ID #: 108, 267, 301

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#: 22

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#: 124,192, 238

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#: 20,143, 168

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#: 21, 54

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#: 21, 367, 403

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#: 44, 45,  164

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

WellCare 

Plan Code: WL2
Rx Bin: 004336

Contract #:S4802

Plan ID#: 13, 118,  155

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