Texas PDP Information 2016

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 #: 56

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

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#: 22

866-250-2005

Call Pharmacy
Help Desk

Click on "Formulary," then select your state, then select appropriate form.

Express Scripts Medicare

Plan Code: MD1
Rx Bin: 610014

Contract #: S5660

Plan ID#: 124,192

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#: 145,179

800-922-1557 800-551-2694 On the bottom of page go to "Tools – Formulary" then "Prior Authorization & Exceptions" then "2016 Part D Prior Authorization & Exception Forms" then select appropriate form.

Humana PDP

Plan Code: HUV
Rx Bin: 015581

Contract #: S5884

Plan ID#: 20,143, 168

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

Magellan Rx Medicare

Plan Code:MAG
Rx Bin: 018117

Contract #: S4607

Plan ID#: 019

800-424-5870 Call Pharmacy Help Desk Obtain PA Form by calling Pharmacy Help Desk line

 

Prescription Solutions
AARP Evercare

Plan Code: UTD
Rx Bin: 610097

Contract #: S5820, S5921

Plan ID#: 21, 193, 367

800-788-7871 800-711-4555 Obtain PA Form by calling PA Line

Secure Horizons 
Evercare Cosmo

Plan Code: SEC
Rx Bin: 610097

  800-797-9794 800-711-4555 Obtain PA Form by calling PA line

Silver Script

Plan Code: SL1
Rx Bin: 004336

Contract #: S5601

Plan ID#: 44, 45

888-865-6567 866-235-5660 Obtain PA Form by calling the PA line

Symphonix Rx

Plan Code: SL1 Rx Bin: 004336

Contract #: S0522

Plan ID#:  39, 69

800-797-9791 800-711-4555 Obtain PA Form by calling the PA line

Transamerica Rx

Plan Code:TRM

Rx Bin: 015774

Contract #: S9579

Plan ID#: 21, 54

888-678-7789  Call Pharmacy Help Desk Obtain PA Form by calling Pharmacy Help Desk line

United American Part D

Plan Code: UA1 
Rx Bin: 004336

Contract #: S5755

Plan ID#: 25,93,126

800-693-4620 866-412-9774 Obtain PA Form by calling PA Line

WellCare

Plan Code: WL2
Rx Bin: 004336

Contract #:S5967

Plan ID#: 159, 193

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

Wellcare Simple

Plan Code:WS1
Rx Bin: 004336

Contract #: S4802

Plan ID#: 13

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