2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
CVS/Caremark (Aetna) Aetna Medicare Aetna Medicare Rx Saver (PDP) Y Y N
AccessHealth, Epic, LeaderNet
(MCC0), Third Party Network,
Brookshire Bros, Albertsons,
Costco, Giant Eagle, Harris Teeter,
HEB, Kroger, Meijers, Rowdys,
Safeway, Sav-Mor, ShopCo, Thrifty
White, Wal-Mart, Walgreens
CVS/Caremark (Aetna) First Health Part D First Health Part D Premier Plus (PDP) Y Y N
AccessHealth, Epic, LeaderNet
(MCC0), Third Party Network,
Brookshire Bros, Albertsons,
Costco, Giant Eagle, Harris Teeter,
HEB, Kroger, Meijers, Rowdys,
Safeway, Sav-Mor, ShopCo, Thrifty
White, Wal-Mart, Walgreens
CVS/Caremark (Aetna) First Health Part D First Health Part D Value Plus (PDP) Y Y N
AccessHealth, Epic, LeaderNet
(MCC0), Third Party Network,
Brookshire Bros, Albertsons,
Costco, Giant Eagle, Harris Teeter,
HEB, Kroger, Meijers, Rowdys,
Safeway, Sav-Mor, ShopCo, Thrifty
White, Wal-Mart, Walgreens
Catamaran Cigna-HealthSpring Rx Cigna-HealthSpring Rx Secure (PDP) Y Y N
LeaderNet, Walgreens, Wal-Mart,
HyVee, Brookshire Brothers,
Kroger, Kmart, Price Chopper
Catamaran Cigna-HealthSpring RxCigna-HealthSpring Rx Secure-Extra
(PDP)Y Y N
LeaderNet, Walgreens, Wal-Mart,
HyVee, Brookshire Brothers,
Kroger, Kmart, Price Chopper
Catamaran/ Regence Asuris Northwest Health Asuris Medicare Script Basic (PDP) Y N
11/18/2015 1 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Catamaran/ Regence Asuris Northwest Health Asuris Medicare Script Enhanced (PDP) Y N
Catamaran/ Regence Regence BlueCross BlueShield of Utah Regence Medicare Script Basic (PDP) Y N
Catamaran/ Regence Regence BlueCross BlueShield of UtahRegence Medicare Script Enhanced
(PDP)Y N
Catamaran/ Regence Regence BlueShield of Idaho Regence Medicare Script Basic (PDP) Y N
Catamaran/ Regence Regence BlueShield of IdahoRegence Medicare Script Enhanced
(PDP)Y N
CVS/Caremark Avalon Insurance Company SecureRx - Option 1 (PDP) Y Y NCVS, Wal-Mart, Walgreens, Rite-
Aid, Target
CVS/Caremark Avalon Insurance Company SecureRx - Option 3 (PDP) Y Y NCVS, Wal-Mart, Walgreens, Rite-
Aid, Target
CVS/ CaremarkBlue Cross and Blue Shield of
MassachusettsBlue MedicareRx Premier (PDP) Y Y N Wal-Mart, Target, CVS
CVS/ CaremarkBlue Cross and Blue Shield of
MassachusettsBlue MedicareRx Value Plus (PDP) Y Y N Wal-Mart, Target, CVS
11/18/2015 2 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
CVS/ Caremark Blue Cross and Blue Shield of Minnesota MedicareBlue Rx Premier (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross and Blue Shield of Minnesota MedicareBlue Rx Standard (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross and Blue Shield of Montana MedicareBlue Rx Premier (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross and Blue Shield of Montana MedicareBlue Rx Standard (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross and Blue Shield of Nebraska MedicareBlue Rx Premier (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross and Blue Shield of Nebraska MedicareBlue Rx Standard (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross and Blue Shield of Vermont Blue MedicareRx Premier (PDP) Y Y N PPOK, Wal-Mart, Target, CVS
CVS/ Caremark Blue Cross and Blue Shield of Vermont Blue MedicareRx Value Plus (PDP) Y Y N PPOK, Wal-Mart, Target, CVS
CVS/ Caremark Blue Cross Blue Shield of North Dakota MedicareBlue Rx Premier (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
11/18/2015 3 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
CVS/ Caremark Blue Cross Blue Shield of North Dakota MedicareBlue Rx Standard (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross Blue Shield of Wyoming MedicareBlue Rx Premier (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark Blue Cross Blue Shield of Wyoming MedicareBlue Rx Standard (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ Caremark SilverScript SilverScript Choice (PDP) Y N
CVS/ Caremark SilverScript SilverScript Plus (PDP) Y Y Y
TriNet, PPOK, United, LeaderNet,
Wal-Mart, Target, CVS, HyVee,
Price Chopper, Walgreens, Hy-Vee
CVS/ CaremarkWellmark Blue Cross and Blue Shield of
IowaMedicareBlue Rx Premier (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ CaremarkWellmark Blue Cross and Blue Shield of
IowaMedicareBlue Rx Standard (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ CaremarkWellmark Blue Cross Blue Shield of South
DakotaMedicareBlue Rx Premier (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
CVS/ CaremarkWellmark Blue Cross Blue Shield of South
DakotaMedicareBlue Rx Standard (PDP) Y Y N
PPOK, CVS/pharmacy, Hy-Vee,
Shopko, Target, Wal-Mart, White
Drug
11/18/2015 4 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
CVS/Caremark United American Insurance Company United American - Enhanced (PDP) Sanctioned Y LeaderNet
CVS/Caremark United American Insurance Company United American - Essential (PDP) Sanctioned Y LeaderNet
CVS/Caremark United American Insurance Company United American - Select (PDP) Sanctioned Y LeaderNet
CVS/ Caremark WellCare WellCare Classic (PDP) Y N; dropped the option for 2016
CVS/Caremark WellCare WellCare Simple (PDP) Y N; dropped the option for 2016
CVS/Caremark WellCare WellCare Extra (PDP) Y N; dropped the option for 2016
EnvisionRx Options EnvisionRx Plus EnvisionRxPlus Silver (PDP) Y Y YTriNet, Price Chopper, Walgreens,
Wal-Mart
EnvisionRx Options EnvisionRx Plus EnvisionRxPlus Clear Choice (PDP) Y Y YTriNet, Price Chopper, Walgreens,
Wal-Mart
Express Scripts Anthem Blue Cross and Blue Shield Anthem Blue MedicareRx Plus (PDP) Y Y N Target, CVS, Wal-Mart
11/18/2015 5 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Express Scripts Anthem Blue Cross and Blue Shield Anthem Blue MedicareRx Premier (PDP) Y Y N Target, CVS, Wal-Mart
Express Scripts Anthem Blue Cross and Blue ShieldAnthem Blue MedicareRx Standard
(PDP)Y Y N Target, CVS, Wal-Mart
Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Premier (PDP) Y Y N Target, CVS, Wal-Mart
Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Value Plus (PDP) Y Y N Target, CVS, Wal-Mart
Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Plus (PDP) Y Y N Target, CVS, Wal-Mart
Express Scripts Anthem Blue Cross and Blue Shield Blue MedicareRx Value (PDP) Y Y N Target, CVS, Wal-Mart
Express ScriptsAnthem Blue Cross Life and Health
Insurance Co
Anthem Blue Cross MedicareRx Gold
(PDP)Y United, Target, CVS
Express ScriptsAnthem Blue Cross Life and Health
Insurance Co
Anthem Blue Cross MedicareRx Plus
(PDP)Y United, Target, CVS
Express ScriptsAnthem Blue Cross Life and Health
Insurance Co
Anthem Blue Cross MedicareRx
Standard (PDP)Y United, Target, CVS
11/18/2015 6 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Express Scripts Blue Cross Blue Shield of Georgia BCBSGa Blue MedicareRx Plus (PDP) Y Y N CVS, Kroger, Wal-Mart
Express Scripts Blue Cross Blue Shield of Georgia BCBSGa Blue MedicareRx Premier (PDP) Y Y N CVS, Kroger, Wal-Mart
Prime Therapeutics Blue Cross Blue Shield of GeorgiaBCBSGa Blue MedicareRx Standard
(PDP)Y Y N CVS, Kroger, Wal-Mart
Express Scripts Blue Cross Blue Shield of Michigan Prescription Blue Option A (PDP) Y Y NUnited, Walgreens, RiteAid,
Kroger, Costco
Express Scripts Blue Cross Blue Shield of Michigan Prescription Blue Option B (PDP) Y Y NUnited, Walgreens, RiteAid,
Kroger, Costco
Express Scripts Blue MedicareRx Blue MedicareRx Plus (PDP) Y Y N
Express Scripts Blue MedicareRx Blue MedicareRx Premier (PDP) Y Y N
Express Scripts Blue MedicareRx Blue MedicareRx Value (PDP) Y Y N
Express Scripts EMI Health Educators Rx Advantage (PDP) Y N
11/18/2015 7 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Express Scripts EMI Health Educators Rx Basic (PDP) Y N
Express Scripts Express Scripts Medicare Express Scripts Medicare - Choice (PDP) Y Y YTriNet, PPOK, United, LeaderNet,
Walgreens
Express Scripts Express Scripts Medicare Express Scripts Medicare - Value (PDP) Y Y YTriNet, PPOK, United, LeaderNet,
Walgreens
Express Scripts HealthNow New York Inc. SmartSaver Rx PDP Value (PDP) Y
Express Scripts Highmark Health Insurance Company Blue Rx PDP Complete (PDP) Y N
Express Scripts Highmark Health Insurance Company Blue Rx PDP Plus (PDP) Y N
Express Scripts WPS Health Insurance WPS MedicareRx Plan 1 (PDP) Y N
Express Scripts WPS Health Insurance WPS MedicareRx Plan 2 (PDP) Y N
MagellanRx Magellan Rx Medicare Magellan Rx Medicare Basic (PDP) Y Y Y TriNet, LeaderNet
11/18/2015 8 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Medimpact QualChoice Advantage SilverSelect Rx (PDP) Y N/A
Medimpact Senior Care PlusSenior Care Plus: Medicare Rx Choice
(PDP)Y
Medimpact Senior Care PlusSenior Care Plus: Medicare Rx Standard
(PDP)Y
Medimpact Stonebridge Life Insurance Company Transamerica MedicareRx Classic (PDP) Y Y N Walgreens
Meridian Advantage-Plus Meridian Advantage-Plus Meridian (PDP) Y N
Prime Therapeutics Arkansas Blue Cross and Blue Shield AR Blue Cross - Medi-Pak Rx Basic (PDP) Y Y NPPOK, LeaderNet, GNPPN, Epic,
Walgreens, Wal-Mart
Prime Therapeutics Arkansas Blue Cross and Blue ShieldAR Blue Cross - Medi-Pak Rx Premier
(PDP)Y N
PPOK, LeaderNet, GNPPN, Epic,
Walgreens, Wal-Mart
Prime Therapeutics Blue Cross and Blue Shield of Alabama BlueRx Option I (PDP) Y Y N
PPOK, LeaderNet, Walgreens,
Medicine Shoppe, Wal-Mart, Rite
Aid, Publix
Prime Therapeutics Blue Cross and Blue Shield of Alabama BlueRx Option II (PDP) Y Y N
PPOK, LeaderNet, Walgreens,
Medicine Shoppe, Wal-Mart, Rite
Aid, Publix
11/18/2015 9 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Prime Therapeutics Blue Cross and Blue Shield of Arizona Blue MedicareRx Enhanced (PDP) Y Y NPPOK, Safeway, CVS, Frys, Target,
Wal-Mart
Prime Therapeutics Blue Cross and Blue Shield of Arizona Blue MedicareRx Value (PDP) Y Y NPPOK, Safeway, CVS, Frys, Target,
Wal-Mart
Prime TherapeuticsBlue Cross and Blue Shield of North
CarolinaBlue Medicare Rx Enhanced (PDP) Y Y N
PPOK, Epic, Walgreens, Wal-Mart,
CVS, RiteAid
Prime TherapeuticsBlue Cross and Blue Shield of North
CarolinaBlue Medicare Rx Standard (PDP) Y Y N
PPOK, Epic, Walgreens, Wal-Mart,
CVS, RiteAid
Prime Therapeutics Blue Cross Blue Shield of South Carolina BlueCross Rx Plus (PDP) Y Y NLeaderNet, Bi-Lo, Rite Aid, Sam's,
Wal-Mart, Walgreens
Prime Therapeutics Blue Cross Blue Shield of South Carolina BlueCross Rx Value (PDP) Y Y NPPOK, LeaderNet, Bi-Lo, Rite Aid,
Sam's, Wal-Mart, Walgreens
Prime Therapeutics Florida Blue BlueMedicare Rx-Option 1 (PDP) Y Y NCVS, Publix, Target, Navarro,
Walgreens
Prime Therapeutics Florida Blue BlueMedicare Rx-Option 2 (PDP) Y Y NCVS, Publix, Target, Navarro,
Walgreens
Prime Therapeutics HISC - Blue Cross Blue Shield of Illinois Blue Cross MedicareRx Basic (PDP) Y Y NPPOK, Sam's, CVS, Jewel-Osco,
Walgreens, Wal-Mart
11/18/2015 10 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Prime Therapeutics HISC - Blue Cross Blue Shield of Illinois Blue Cross MedicareRx Plus (PDP) Y Y NPPOK, Sam's, CVS, Jewel-Osco,
Walgreens, Wal-Mart
Prime Therapeutics HISC - Blue Cross Blue Shield of Illinois Blue Cross MedicareRx Value (PDP) Y Y NPPOK, Sam's, CVS, Jewel-Osco,
Walgreens, Wal-Mart
Prime TherapeuticsHISC - Blue Cross Blue Shield of New
MexicoBlue Cross MedicareRx Basic (PDP) Y Y N
Sam's, CVS, Allbertsons,
Walgreens, Wal-Mart
Prime TherapeuticsHISC - Blue Cross Blue Shield of New
MexicoBlue Cross MedicareRx Plus (PDP) Y Y N
Sam's, CVS, Allbertsons,
Walgreens, Wal-Mart
Prime TherapeuticsHISC - Blue Cross Blue Shield of New
MexicoBlue Cross MedicareRx Value (PDP) Y Y N
Sam's, CVS, Allbertsons,
Walgreens, Wal-Mart
Prime Therapeutics HISC - Blue Cross Blue Shield of Oklahoma Blue Cross MedicareRx Basic (PDP) Y Y NPPOK, CVS, Walgreens, Wal-Mart,
AccessHealht, PPOK
Prime Therapeutics HISC - Blue Cross Blue Shield of Oklahoma Blue Cross MedicareRx Plus (PDP) Y Y NPPOK, CVS, Walgreens, Wal-Mart,
AccessHealht, PPOK
Prime Therapeutics HISC - Blue Cross Blue Shield of Oklahoma Blue Cross MedicareRx Value (PDP) Y Y NPPOK, CVS, Walgreens, Wal-Mart,
AccessHealht, PPOK
Prime Therapeutics HISC - Blue Cross Blue Shield of Texas Blue Cross MedicareRx Basic (PDP) Y Y NPPOK, CVS, HEB, Sam's, Walgreens,
Wal-Mart, AccessHealth
11/18/2015 11 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
Prime Therapeutics HISC - Blue Cross Blue Shield of Texas Blue Cross MedicareRx Plus (PDP) Y Y NPPOK, CVS, HEB, Sam's, Walgreens,
Wal-Mart, AccessHealth
Prime Therapeutics HISC - Blue Cross Blue Shield of Texas Blue Cross MedicareRx Value (PDP) Y Y NPPOK, CVS, HEB, Sam's, Walgreens,
Wal-Mart, AccessHealth
Prime TherapeuticsHorizon Blue Cross Blue Shield of New
Jersey
Horizon Medicare Blue Rx Enhanced
(PDP)Y Y N
LeaderNet, CVS, Rite Aid,
Walgreens, Wal-Mart
Prime TherapeuticsHorizon Blue Cross Blue Shield of New
Jersey
Horizon Medicare Blue Rx Standard
(PDP)Y Y N
LeaderNet, CVS, Rite Aid,
Walgreens, Wal-Mart
Prime Therapeutics UTIC Insurance Company BlueRx Option I (PDP) Y Y NPPOK, LeaderNet, CVS, Rite Aid,
Walgreens, Wal-Mart
Prime Therapeutics UTIC Insurance Company BlueRx Option II (PDP) Y Y NPPOK, LeaderNet, CVS, Rite Aid,
Walgreens, Wal-Mart
11/18/2015 12 of 13 Chart subject to change
2016 Medicare Part D
Preferred Network Status
Confidential
PBM Company Plan
Is TriNet Contracted with
this plan?Y/N
Does this plan offer Preferred Networks(i.e. patients are only
allowed to go to certain pharmacies/ PSAOs that
participate)?Y/N
If Preferred, are TriNet Pharmacies listed as
Preferred?Y/N
What Chains/ PSAOs are in these preferred
networks?
BS of California Blue Shield of California Blue Shield Medicare Basic Plan (PDP) N
BS of CaliforniaBlue Shield of California
Blue Shield Medicare Enhanced Plan
(PDP) N
Humana Humana Insurance Company Humana Enhanced (PDP) N Y
Humana Humana Insurance Company Humana Preferred Rx Plan (PDP) N Y
Humana Humana Insurance Company Humana Walmart Rx Plan (PDP) N Y
HumanaHumana Insurance Company of New York
Humana Enhanced (PDP) N Y
HumanaHumana Insurance Company of New York
Humana Preferred Rx Plan (PDP) N Y
HumanaHumana Insurance Company of New York
Humana Walmart Rx Plan (PDP) N Y
Humana Humana Insurance of Puerto Rico, Inc. Humana Enhanced (PDP) N Y
Humana Humana Insurance of Puerto Rico, Inc. Humana Preferred Rx Plan (PDP) N Y
OptumRx Symphonix Health Symphonix PrimeSaver Rx (PDP) N Y
OptumRx Symphonix Health Symphonix Value Rx (PDP) N Y
OptumRx UnitedHealthcare AARP MedicareRx Preferred (PDP) N Y
OptumRx UnitedHealthcare AARP MedicareRx Saver Plus (PDP) N Y
11/18/2015 13 of 13 Chart subject to change