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Commercial-Employer Plans

Prescription Drug Coverage & Medication Management
Commercial-Employer Plans
(Highlights drug coverage by plan, prior approval guidelines, critical forms and other helpful information for healthcare providers and consumers)

Commercial-Employer Plans Executive Summary

Commercial employer plans differ in that fewer plan options are available. Typically only one plan is available. Additionally, preferred drug lists are given instead of tiered drug lists. This results in fewer medications being covered by the plans. Prior authorization forms are not readily available making it difficult to determine if additional coverage is possible. Also, several plans require login credentials making it difficult for patients and providers to determine coverage. When plan information is available, it is listed on the employer’s benefits webpage.  These plans are less likely to promote the use of mail order pharmacies. Many plans link with large pharmacy benefits managers (ex. Caremark) to offer a predetermined drug list. Employers do not make it clear as to whether plan specific exceptions are made to drug lists supplied by the pharmacy benefits manager.

Plan Name (alphabetical order) PBM/ Insurers Name Formulary List Site / pdf Prior Authorization Criteria Prior Authorization Form Site / Specialty Medication Forms Specific Forms by Drug Mail Order/ Specialty Pharmacy Other Helpful Links Workers Compensation
Adventist Health System   pdf N/A N/A N/A N/A N/A N/A
AFTRA   Link N/A N/A N/A N/A N/A N/A
AIDS Drug Assistance Program (NC)   pdf N/A N/A N/A N/A N/A N/A
AmWINS Rx   Link N/A N/A N/A Specialty Pharmacy N/A N/A
pdf N/A N/A N/A Mail Order Pharmacy
Basic Core Formulary Military Treatment Faci   Link N/A N/A N/A N/A N/A N/A
BeyondRx   pdf N/A N/A N/A N/A N/A N/A
Boeing   Preventive Medications pdf N/A N/A N/A Mail Order Pharmacy N/A N/A
BOP of the Presbyterian Church   pdf Link N/A N/A Mail Order Pharmacy Specialty Drug List N/A
BOP of the Presbyterian Church Retirees   pdf Link N/A N/A N/A N/A N/A
Bureau of Prisons - National Formulary   pdf N/A N/A N/A N/A N/A N/A
CarMax CVS Caremark pdf N/A N/A N/A N/A N/A N/A
Cascade Die Casting   pdf N/A N/A N/A N/A N/A N/A
Catamaran (Advantage)   pdf N/A N/A N/A N/A N/A N/A
Catamaran (National)   pdf N/A  800-880-1188 N/A N/A N/A N/A
Citigroup Express Scripts pdf N/A N/A N/A N/A N/A N/A
Costco Member Prescription Program   pdf N/A N/A N/A N/A N/A N/A
CVS/pharmacy Health Savings Pass CVS Caremark pdf N/A N/A N/A N/A N/A N/A
Delta Air Lines United Healthc pdf N/A N/A N/A N/A Drug Pricing Tool N/A
Duke University Express Scripts Link Link Link Yes Mail Order Pharmacy N/A Workers Compensation
EliteCare   pdf N/A N/A N/A Mail Order Pharmacy (must enter group number) N/A N/A
Enterprise Rent-A-Car Express Scripts Link N/A N/A N/A N/A N/A N/A
pdf N/A N/A N/A N/A
FedEx Express Scripts pdf N/A N/A N/A N/A N/A N/A
Ford Motor Company (UAW) Medco pdf N/A N/A N/A Mail Order Pharmacy N/A N/A
GEHA Medco Link N/A pdf Yes Mail Order Pharmacy N/A N/A
pdf N/A N/A
General Electric (Retiree) SilverScript pdf N/A N/A N/A N/A N/A N/A
General Motors (UAW)   N/A N/A N/A N/A N/A N/A N/A
General Prescription Programs   pdf N/A N/A N/A N/A N/A N/A
Golden Rule (3-Tier) United Healthc pdf N/A N/A N/A N/A N/A N/A
Golden Rule (4-Tier)   pdf N/A N/A N/A N/A N/A N/A
HealthTrans Catamaran pdf Link 800-880-1188 N/A N/A N/A N/A
Indian Health Services   Link N/A N/A N/A N/A N/A N/A
pdf N/A N/A N/A N/A
Kroger Generic Drug Program   Link N/A N/A N/A N/A N/A N/A
LDI Integrated Pharmacy Services   pdf N/A 314-652-1121 or 866-516-3121 N/A Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
Mail Handlers CVS Caremark pdf Link N/A N/A Mail Order Pharmacy N/A N/A
Martin Marietta (Retiree) SilverScript pdf N/A pdf No Mail Order Pharmacy N/A N/A
Maxcare   pdf N/A pdf No Specialty Pharmacy N/A N/A
Maxor Plus   pdf Link 800-687-0707 N/A N/A N/A N/A
MedImpact (MedCare)   N/A N/A pdf No N/A N/A N/A
MedImpact (Select)   N/A N/A pdf No N/A N/A N/A
Microsoft CVS Caremark pdf N/A N/A N/A N/A N/A N/A
National Pharmaceutical Services   pdf N/A N/A N/A Mail Order Pharmacy N/A N/A
Naval Branch Health Clinic (Cherry Point)   Link Link pdf Yes Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
Naval Hospital (Camp Lejeune)   Link Link pdf N/A Specialty Pharmacy N/A N/A
  Yes Mail Order Pharmacy N/A N/A
Partners Rx Standard   pdf N/A pdf No N/A N/A N/A
Partners Rx Standard Plus   pdf N/A pdf No N/A N/A N/A
PBM Plus   pdf N/A pdf No Mail Order Pharmacy N/A N/A
Perdue Farms Express Scripts Link N/A 888-676-7906 N/A N/A N/A N/A
PerformRx   pdf N/A N/A N/A Specialty Pharmacy N/A N/A
Pharmaceutical Horizons (Focus Formulary)   pdf N/A N/A N/A N/A N/A N/A
Preferred Prescriptions (Medco) Medco pdf N/A N/A N/A Mail Order Pharmacy N/A N/A
PrimeChoice Accord (National)   pdf N/A pdf No Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
PrimeChoice Essential   pdf N/A pdf No Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
PrimeChoice Plus   pdf N/A pdf No Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
ProCare Rx   pdf N/A pdf Yes Mail Order Pharmacy N/A N/A
Restat   pdf N/A pdf Yes Specialty Pharmacy N/A N/A
Robert Bosch CVS Caremark pdf N/A N/A N/A N/A N/A N/A
RxEDO   pdf N/A N/A N/A N/A N/A N/A
RxSelections (Medco) Medco pdf N/A N/A N/A N/A N/A N/A
SAMBA CVS Caremark pdf N/A N/A N/A Mail Order Pharmacy N/A N/A
Schneider Electric USA (Retiree) SilverScript pdf N/A pdf No Mail Order Pharmacy N/A N/A
Serve You   pdf N/A pdf N/A N/A N/A N/A
Seymour Johnson AFB (4th Medical Group)   pdf N/A N/A N/A N/A N/A N/A
Starmark CVS Caremark pdf N/A N/A N/A N/A N/A N/A
Target Generic Drug Program   pdf N/A N/A N/A Specialty Pharmacy N/A N/A
Travelers Express Scripts pdf N/A N/A N/A N/A N/A N/A
Tricare   pdf Link pdf Yes Mail Order Pharmacy N/A N/A
Trustmark (Caremark Plan)   pdf N/A N/A N/A N/A N/A N/A
Trustmark (Wellpoint Plan) Express Scripts pdf N/A N/A N/A N/A N/A N/A
United Mine Workers of America   pdf N/A 800-294-5979 N/A Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
US Coast Guard (Elizabeth City)   pdf Link pdf Yes Mail Order Pharmacy N/A N/A
USG (Retiree) SilverScript pdf N/A N/A N/A N/A N/A N/A
US Script National Preferred (Commercial)   pdf Prior Authorization (See Page 22) pdf No Mail Order Pharmacy N/A N/A
Ventegra Preferred   pdf N/A N/A N/A N/A N/A N/A
Ventegra Premium   pdf N/A N/A N/A N/A N/A N/A
Ventegra Premium Plus   pdf N/A N/A N/A N/A N/A N/A
Walgreens Prescription Savings Club   pdf N/A N/A N/A Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
Walmart $4 Prescription Program   pdf N/A N/A N/A Specialty Pharmacy N/A N/A
Mail Order Pharmacy N/A N/A
WellDyneRx   Link Link N/A N/A Specialty Pharmacy N/A N/A
pdf Mail Order Pharmacy
Wells Fargo CVS Caremark pdf N/A N/A N/A N/A N/A N/A
Womack Army Med Center   pdf Link pdf Yes Mail Order Pharmacy N/A N/A

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