Pharmacy
A Prescription Drug List (PDL), also called a formulary, is a list of drugs included with a plan's prescription drug benefits. Below is the list of PDLs by group size.
2021 Pharmacy Guide
Effective Jan. 1, 2021
| Line of Business | Rx Network | PDL | |
| Individual | Armor Health | Network J | PDL 40 |
| Small Group |
Small Group ACA (2- 50 employees) |
Network J | PDL 64 (1/1/21 renewals and after) OR PDL 63 (until 2021 renewal) |
| Small Group, Level-funded (5-50 employees) |
Network C (ESN) | PDL 40 | |
| Mid-size Group (51-150 employees) |
Network C (ESN) | PDL 40 | |
| Large Group |
Large Group, Fully Insured (151+ employees) |
Network C (ESN) | PDL 40 |
| Self-funded Groups (Block - 51+ employees) |
Network C (ESN) | PDL 10, PDL 20 | |
| Self-funded Groups (Other than block) |
Varies | Varies | |
Each pharmacy network listed is a separate option and offered independently.
Network A: All major chains, including CVS/Target pharmacies, are part of this network.
- Network A without Extended Supply Network (ESN) allows both a 30-day and 90-day supply at retail locations.
- Network A with ESN allows up to a 30-day supply at retail and up to a 90-day supply through an ESN pharmacy.
Network C: This network excludes CVS/Target pharmacies.
- Network C without ESN allows both a 30-day and 90-day supply at retail locations.
- Network C with ESN allows up to a 30-day supply at retail and up to a 90-day supply through an ESN pharmacy.
Network G: This is a tiered network which excludes CVS/Target pharmacies. Preferred pharmacies are in Tier 1, where members pay a lower cost share. Members pay a higher share for prescriptions filled at Tier 2 pharmacies.
Network J: This network excludes CVS/Target and Costco pharmacies. It allows members to fill either a 30-day or 90-day supply at any in-network pharmacy.
Each PDL is a separate option and offered independently.
PDL 10: Broad prescription drug list available for our self-funded clients.
PDL 20: Prescription drug list available for our self-funded clients.
PDL 30: Prescription drug list available for our self-funded clients.
PDL 40: Standard preferred prescription drug list.
PDL 63: 2020 small group ACA covered drug list. Small groups will remain on this list until their 2020 renewal.
PDL 64: Small group ACA covered drug list for 2021.
2020 Pharmacy Guide
| Line of Business | Rx Network | PDL | |
| Individual | Armor Health | Network J | PDL 40 |
| Small Group |
Small Group ACA (2- 50 employees) |
Network J | PDL 63 (1/1/20 renewals and after) OR PDL 62 (until 2020 renewal) |
| Small Group, Level-funded (5-50 employees) |
Network C (ESN) | PDL 40 | |
| Mid-size Group (51-150 employees) |
Network C (ESN) | PDL 40 | |
| Large Group |
Large Group, Fully Insured (151+ employees) |
Network C (ESN) | PDL 40 |
| Self-funded Groups (Block - 51+ employees) |
Network C (ESN) | PDL 10 | |
| Self-funded Groups (Other than block) |
Varies | Varies | |
Each pharmacy network listed is a separate option and offered independently.
Network A: All major chains, including CVS/Target pharmacies, are part of this network.
- Network A without Extended Supply Network (ESN) allows both a 30-day and 90-day supply at retail.
- Network A with ESN allows up to a 30-day supply at retail and up to a 90-day supply through and ESN pharmacy.
Network C: This network excludes CVS/Target pharmacies.
- Network C without ESN allows both a 30-day and 90-day supply at retail.
- Network C with ESN allows up to a 30-day supply at retail and up to a 90-day supply through an ESN pharmacy.
Network G: This is a tiered network which excludes CVS/Target pharmacies. Preferred pharmacies are in Tier 1, where members will pay a lower cost share. Members would pay a higher copay for prescriptions filled at Tier 2 pharmacies.
Network J: This network excludes CVS/Target pharmacies. It allows members to fill either a 30-day or 90-day supply at any in-network pharmacy.
Each PDL is a separate option and offered independently.
PDL 10: This is our broad prescription drug list available for our self-funded clients.
PDL 20: This prescription drug list is available for our self-funded clients.
PDL 30: This prescription drug list is available for our self-funded clients.
PDL 40: This is our standard preferred prescription drug list.
PDL 62: This is the 2019 small group ACA covered drug list. Small groups will remain on this list until their 2020 renewal.
PDL 63: This is the 2020 small group ACA covered drug list.