Formulary & Pharmacy Changes

Formulary and Pharmacy Network Changes

Formulary Changes
The total number of CDPHP formularies has expanded to four, as CDPHP is administering two different formularies for our commercial business.

• Formulary 1—Our large employer groups (greater than 50 eligible employees) are retaining the current CDPHP formulary.

• Formulary 2—All individual enrollees and small employer groups (50 or fewer eligible employees) are receiving drug benefits based on a new closed formulary that is dictated by the Essential Health Benefits package that all insurers marketing products on the NY State of Health must offer.

Full details on both formularies are available in Rx Corner Formulary Updates and Epocrates.

Pharmacy Network Changes
To gain access to their prescription drug benefit, individual members, Medicaid Select Plan members, and Child Health Plus members need to have their prescriptions filled at a CVS, Hannaford, Price Chopper, ShopRite, Walmart, and certain independent pharmacies in the Value Rx Network. The following pharmacies are not part of the Value Rx Network: Rite Aid, Kinney Drugs, Walgreens, and Target.

All commercial group members continue to have access to the full Caremark pharmacy network currently in place, which is known as the Premier Rx Network.

ID Cards Reflect the Difference
Your office will be able to readily identify which members have Formulary 2 and the Value Rx Network, as this information is imprinted in the lower right corner of the front of their member ID cards.