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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.

Coming July 2021 – New specialty and home delivery pharmacies

Starting July 1, 2021, home delivery pharmacy services will be provided by Express Scripts Pharmacy and specialty drug pharmacy services will be provided by Accredo.

Specialty Pharmacy:
Accredo is a specialty pharmacy that serves patients with complex and chronic health conditions, including cancer, hepatitis C, HIV, bleeding disorders and multiple sclerosis.
Accredo has:

  • Access to 99.9% of specialty drugs
  • 500 condition-specific pharmacists
  • 600+ nurses
  • One-on-one counseling from specialist pharmacists and nurses
  • 350 proprietary clinical protocols maximize safety, effectiveness and affordability
  • 15 Therapeutic Resource Centers®(TRC), each focused on a specific specialty condition


Home Delivery Pharmacy:
Express Scripts Pharmacy has been serving members with prescription delivery for over 30 years. At Express Scripts Pharmacy there are pharmacists and support staff available
24 hours a day, 7 days a week to help with any medication questions or concerns.

Express Scripts Pharmacy is a pharmacy that is contracted to provide home delivery services to members of Blue Cross and Blue Shield of Nebraska. Express Scripts Pharmacy is a trademark of Express Scripts Strategic Development, Inc. Accredo is a specialty pharmacy that is contracted to provide services to members of Blue Cross and Blue Shield of Nebraska. Accredo is a trademark of Express Scripts Strategic Development, Inc.