Exhibit_A,_Attachment_A.2_-_Medicare_Part_D_Pharmacy_List.xlsx

XLSX spreadsheet 26 KB Posted

Attached to
Medicare Supplement and Part D Pharmacy Insurance
Solicitation number
26-P-67TF
Issued by
Volusia County, Florida

About this file

This is a Medicare Part D Pharmacy Network List attachment for Volusia County, Florida's Medicare Supplement and Part D Pharmacy Insurance contract opportunity. The document requires contractors to identify their in-network pharmacy providers by marking an "X" in the designated column for each pharmacy included in their network. The list includes ten major pharmacy providers: Costco Pharmacy, CVS Pharmacy, Daytona Discount Pharmacy, Guardian Pharmacy, Medicine Shoppe, Publix Pharmacy, Sam's Club Pharmacy, Target Pharmacy, Walmart Pharmacy, and Walgreens Pharmacy. Contractors must provide a minimum network of these pharmacy providers for the plan effective January 1, 2027, which covers Medicare-eligible retirees and their eligible dependents from Volusia County government and participating agencies. The contractor must maintain separate eligibility reporting by agency and coordinate with the current Third Party Administrator, WEX, for eligibility, enrollment, and billing management.

The file specifies plan configuration options including HMO, PPO/EPO/POS, and Fee for Service Supplement plans with varying prescription drug coverage categories. Drug coverage is categorized as generic drugs with no exclusions, brand preferred and brand non-preferred prescription drugs, specialty drugs, and non-covered drugs, with options for plans with high deductibles. The pharmacy network structure supports a Part D prescription drug plan component, with the ability to accommodate Major Chains limited networks or enhanced network options depending on the selected plan type.

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Text version

Pharmacy Legal Company Name

Instructions:

1. Contractor shall provide, at a minimum, the following pharmacy providers in the network for the Plan.

2. Provide your Legal Company Name at the top of this sheet.

3. Place an X in the "In-Network" column beside each pharmacy provider that is in your network for the Plan. Leave the field blank if the provider is not in your network. Do Not Re-sort.

PharmacyIn Network
COSTCO PHARMACY
CVS PHARMACY
DAYTONA DISCOUNT PHARMACY
GUARDIAN PHARMACY
MEDICINE SHOPPE
PUBLIX PHARMACY
SAM'S CLUB PHARMACY
TARGET PHARMACY
WALMART PHARMACY
WALGREENS PHARMACY

&"Arial,Bold"&12 26-P-67TF Attachment A.2 - Medicare Part D Pharmacy List

COUNTY OF VOLUSIA - MEDICAL AND PHARMACY PLAN FOR MEDICARE ELIGIBLE RETIREES

PHARMACIES

drop down box

Drug Plan TypePCP RequiredRX NetworkMedical Plan Type
Partial Part DYesMajor ChainsHMO
100% Part DNoLimited NetworkPPO/EPO/POS
Part D EnhancedFee for Service
Supplement plansDrug listOOP ExclusionsMedicare Part B Drugs
AGenericNoneCovered under Medical
BBrand PreferredPrescription DrugsCovered under Pharmacy
CBrand Non-preferred
DSpecialty
FNot Covered
F with a high deductible
G
K
L
M
N

File details come from the government source that posted it. Updated .