New PBM effective January 1, 2020

Here’s what you need to know.

As a reminder, we are transitioning to a new pharmacy benefit manager (PBM) effective Jan. 1, 2020. Below is a quick recap of what you need to know.

Enhancements for next year

Here are just a few of the improvements coming in January.

We will be offering some exciting new customer enhancements, including:

  • Dedicated prescription helplines staffed by experts who are available to answer all customer, provider and pharmacist questions 24/7.
  • An improved digital pharmacy experience that allows members to access pharmacy benefit, network and cost information through our website and Sharp Connect.
  • Enhanced digital tools, like the free CVS Caremark® mobile app that lets members see their personalized pharmacy benefit information, refill or request new mail service prescriptions, track order status, view prescription history and much more.

2020 formulary changes

Our drug list is changing.

We are updating our formulary (or drug list) in 2020. We have notified members who are currently taking drugs that have formulary changes for next year. Our communications directed members to work with their providers if they had questions about their medications. To help make this a smooth transition, we are honoring all existing pharmacy prior authorizations until the date noted on the member’s original approval letter from Sharp Health Plan.

Please note, if you are enrolled in benefits on our Tier 3 formulary, your employees will have a 31-day grace period on their current medications if they are negatively impacted by the 2020 formulary changes. These employees will have until Feb. 1, 2020 before the negative changes go into effect. All other changes will still be effective Jan. 1, 2020. We have notified your employees, and their doctors, of their specific formulary effective dates in our communications. If you aren’t sure what Tier formulary you’re enrolled in, please contact your account management executive.

New member ID cards

New 24/7 prescription helpline, plus new BIN and PCN info.

All members will receive new member ID cards by the end of December. These cards will include a new, dedicated prescription helpline for 24/7 support with pharmacy-related questions and new BIN and PCN information. New cards will be effective Jan. 1, 2020.

Plan Type 24/7 Prescription helpline BIN PCN
Commercial, Exchange 1-855-298-4252 004336 ADV


If you have questions, here’s where you can find more information.

Please direct employees with pharmacy questions to Beginning Jan. 1, 2020, they can also call the pharmacy helpline. The number will be printed on the back of their new member ID card. If you have questions, please visit or contact your account management executive.