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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.