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New Pharmacy Benefit Manager

Important Pharmacy Benefit Changes

New Pharmacy Benefit Manager

Effective January 1, 2023, Capital Rx will become the new pharmacy benefit manager (PBM) for CDPHP. We’re teaming up with Capital Rx to improve quality and decrease costs, plus increase access and transparency. Here is some additional information.

What will this change mean for me?

All CDPHP members will be receiving new ID cards between October and December 2022. The new ID card has a pharmacy claim processing number (called a BIN) that your pharmacy needs to fill any prescriptions for you. You’ll need to start using your new card on January 1, 2023. Because of the new pharmacy benefit manager, you will need to show your new ID card when you fill a prescription.


Does Capital Rx fill prescriptions?

Capital Rx is not a pharmacy and cannot fill prescriptions. They simply manage the pharmacy benefit behind the scenes.


Do I need to change to a different pharmacy?

This depends on the type of health plan you have. Learn more here.


What is a pharmacy benefit manager?

Pharmacy benefit managers, or PBMs, manage prescription drug benefits on behalf of health insurers. PBMs have a significant behind-the-scenes impact in determining the costs of prescription medications for insurers, and ultimately patients.


What do you know about Capital Rx?

With more than 150 clients covering more than one million lives, Capital Rx is one of the fastest growing health care companies in America and offers game-changing technology in both claims processing and benefit configuration.

By partnering with Capital Rx, CDPHP aims to stem the tide of rising drug prices through greater price transparency, as well as a new pricing model that more accurately and fairly sets the cost of drugs. We are proud to say that Capital Rx sets its prices with full transparency using actual unit drug costs based on the National Average Drug Acquisition Cost (NADAC), which is maintained by the Centers for Medicare and Medicaid Services (CMS).

Additionally, Capital Rx is more agile than any other PBM on the market. It can modify formularies (list of covered drugs) in days rather than weeks or months. As new, more affordable drugs come to market, CDPHP will be able offer those products more quickly to our members.


How do I view pharmacy benefit coverage?

You can view pharmacy benefit coverage by logging in to your online CDPHP member account. You can also download the ConnectRx, On the Go app to view your prescriptions all in one place. On the app you can view cost-saving alternatives, change pharmacies, and receive updates about Rx benefit changes. Need extra help? You can also call member services at the number on your ID card for assistance.


Change Pharmacies in the Palm of Your Hand

Download the CDPHP ConnectRx, On the Go app to change pharmacies quickly and easily, plus stay updated about prescription benefit changes, view prescriptions, and more.

Learn more

Pending NYS DOH approval