Medicare RX BIN routing guide

No current Medicare card: start with E1

1. Submit an E1 eligibility transaction through the pharmacy's established Medicare workflow.
2. Use the returned Part D BIN, PCN, group, and cardholder ID together.
3. Check coverage dates and save the response date with the route.
4. Keep supplemental, Medicare Prescription Payment Plan, and other secondary fields separate from the primary Part D route.
5. Read the claim response before changing the route again. A formulary, refill, or authorization reject can confirm that routing succeeded.

The current CMS Plan Communication User Guide describes the E1 transaction pharmacists use to obtain beneficiary billing information. CMS limits the transaction to permitted Medicare pharmacy and coordination-of-benefits purposes.

BIN and PCN combinations in 2026 Medicare plan records

The selected combinations below come from the CMS BIN/PCN extract dated July 1, 2026. They include broadly reused routes and additional regional combinations that account for substantial enrollment in the CMS July 2026 enrollment file. The record counts do not measure beneficiary enrollment, prescription volume, or pharmacy claim frequency.

Find a Medicare pharmacy route in this guide

Search the published route tables in this guide by BIN, PCN, program, or context. Use the beneficiary's current card or E1 response to keep the BIN, PCN, RxGroup, and member ID together for a live claim.

RX BIN	PCN	Active CMS plan records	Published context	Source
610097	9999	1,242	OptumRx Part D and Medicare Advantage prescription drug records	CMS 2026 extract
015581	03200000	1,050	Broadly reused Part D route; group and member ID remain plan-specific	CMS 2026 extract
610502	MEDDAET	953	Aetna Medicare processing through CVS Caremark	CMS 2026 extract
004336	MEDDADV	949	CVS Caremark Medicare Part D records	CMS 2026 extract
610014	MEDDPRIME	683	Express Scripts-administered route reused by Wellcare, Express Scripts Medicare, Highmark, and other sponsors	CMS 2026 extract
020115	IS	455	CVS Caremark Medicare route used by multiple sponsors	CMS 2026 extract
017010	CIMCARE	394	Cigna Medicare prescription drug records	CMS 2026 extract
003858	MD	262	Express Scripts-administered route used by multiple Medicare sponsors	CMS 2026 extract
610011	CTRXMEDD	257	OptumRx Medicare client records	CMS 2026 extract
015574	ASPROD1	190	MedImpact-administered route used by multiple Part D sponsors	CMS 2026 extract
610602	NVTD	137	Navitus-administered route used by Geisinger, Moda, and other sponsors	CMS 2026 extract
012312	PARTD	87	MedImpact-administered route used by MCS, Astiva, and other sponsors	CMS 2026 extract
610455	AHPPARTD	74	Alignment Health Plan Medicare route processed by Prime Therapeutics	CMS 2026 extract
611791	CARELONRX	60	CarelonRx Part D records	CMS 2026 extract
610674	abarcaD	40	Abarca Medicare records	CMS 2026 extract
015581	03200008	37	CarePlus Medicare plans; do not substitute for the more widely reused 03200000 route	CMS 2026 extract
026696	77993322	30	Blue Shield of California Medicare plans	CMS 2026 extract
610770	CRXMD	30	Judi Rx, formerly Capital Rx, Medicare records	CMS 2026 extract
012635	NA	30	Independent Health and Pharmacy Benefit Dimensions Medicare plans	CMS 2026 extract
610674	PHPMEDDRX	28	Prominence Health Plan Medicare records	CMS 2026 extract
012833	MedDPrime	26	Florida Blue and BlueMedicare records; preserve the PCN casing returned by the card or E1 response	CMS 2026 extract
015938	7463	26	Select Health Medicare records	CMS 2026 extract
011859	MACMSA	26	Kaiser Permanente Mid-Atlantic Medicare records	CMS 2026 extract
610455	SOMAPD	25	Solis Health Plans Medicare records	CMS 2026 extract
011842	NCCMS	23	Kaiser Permanente Northern California Medicare records	CMS 2026 extract
020388	IRXMEDD	19	CVS Caremark-administered Medicare Part D route used by multiple sponsors	CMS 2026 extract
011172	SCCMS	12	Kaiser Permanente Southern California Medicare records	CMS 2026 extract
610455	NY4000	12	EmblemHealth Medicare records	CMS 2026 extract
014897	MBG	11	Blue Cross and Blue Shield of Alabama Blue Advantage records	CMS 2026 extract
021692	CTRXMEDD	11	BlueCross BlueShield of South Carolina Medicare records	CMS 2026 extract
610455	EMNH5959	8	Blue Cross and Blue Shield of Minnesota Medicare Advantage records	CMS 2026 extract
011255	COCMS	8	Kaiser Permanente Colorado Medicare records	CMS 2026 extract
015905	HMONC	6	Blue Cross and Blue Shield of North Carolina Blue Medicare HMO records	CMS 2026 extract
610602	EGWP	6	Navitus MedicareRx employer group records	CMS 2026 extract
011230	NWCMS	5	Kaiser Permanente Northwest Medicare records	CMS 2026 extract
610455	KSPDP	4	Blue Cross and Blue Shield of Kansas Blue MedicareRx PDP records	CMS 2026 extract

PillPilot calculated these counts from records whose effective dates included July 1, 2026. CMS preserves source casing, so values such as MEDDPRIME and MedDPrime remain separate. The combinations are useful for confirming that a route appears in the current CMS file. They cannot answer which plan covers the person standing at the counter.

The OptumRx 2026 Medicare payer sheet publishes the Kaiser regional PCNs above. The Prime Therapeutics 2026 Medicare payer sheet publishes plan-specific groups for its routes, including S5726 for KSPDP, NCPARTD for HMONC, and 90100 for MBG. Other groups vary by plan and should come from the current card or E1 response.

Part D, Part B, and supplemental routes are different

A processor can publish both Part D and Part B PCNs under the same BIN. The product, benefit, and card label decide which billing path applies. The Other Coverage Code guide covers the primary-result field used in eligible secondary pharmacy claims.

Current published Part B examples

There is no national CMS Part B BIN/PCN extract equivalent to the Part D file above. The following examples come from the CVS Caremark Medicare payer sheet v2.0.7, effective January 2026. This is a processor-specific reference, not a complete list of Medicare Part B routes. Caremark requires the RxGroup communicated by the plan or printed on the card.

The same current Caremark sheet also publishes 028272 / MOHMCARE for Molina Medicare Part D, effective January 1, 2026. That route does not appear in the July 1 CMS contract-plan extract, so use it only when the current card, E1 response, or payer instruction identifies it.

PACE processor IDs need their own check

PACE organizations appear in the CMS Part D file, but some publish a processor ID or IIN that is not a six-digit RX BIN. The July 1, 2026 CMS extract includes these widely reused PACE examples:

PACE combinations are not interchangeable. Use the participant's current PACE card or E1 result and retain every returned routing field. Do not pad a seven-character CMS processor ID into a six-digit BIN field.

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets Part D enrollees spread out-of-pocket prescription costs across the calendar year. All Part D plans must offer it. The plan-specific M3P BIN and PCN are used after the primary Part D claim, not in place of the beneficiary's primary route.

1. Submit the prescription to the beneficiary's primary Part D BIN, PCN, RxGroup, and member ID.
2. Read the paid response. For an enrolled participant, the response supplies the plan's M3P BIN and PCN.
3. Submit any permitted supplemental or other-insurance transactions before M3P.
4. Submit the final participant responsibility as a coordination-of-benefits transaction to the M3P BIN and PCN returned by the plan.
5. Confirm the final response shows zero patient responsibility before completing the sale.

The CMS final part one guidance describes this sequence. The CMS M3P pharmacy FAQ clarifies that the M3P transaction is not separate other health insurance and should be submitted after other payers. When an I/T/U pharmacy dispenses at no cost to an IHS-eligible enrollee, CMS instructs the pharmacy not to submit the M3P transaction.

M3P BIN and PCN snapshot for July 1, 2026

The table below contains all 88 case-sensitive M3P BIN or IIN and PCN combinations with an active record in the CMS July 1, 2026 extract. The count is the number of active contract-plan records, not participants or claims. Use the M3P route returned on the paid primary response; do not choose a route from this table by BIN alone.

CMS records can contain uncommon spellings, casing, or processor IDs. This table preserves the published values rather than normalizing them. A value that appears once is still not proof that it belongs to the beneficiary's plan.

Dedicated Medicare program routes

Medicare LI NET at the counter

LI NET can provide temporary coverage while an eligible beneficiary moves into a Part D plan. CMS program resources publish BIN 015599 and PCN 05440000. Confirm eligibility, use the beneficiary identifier required by the current program instruction, and do not replace an active Part D route merely because the LI NET combination is familiar. Use CMS eligibility and program instructions for the beneficiary's claim.

Medicare GLP-1 Bridge pharmacy workflow

The CMS pharmacy page states that the Bridge runs from July 1, 2026 through December 31, 2027 and operates outside the normal Part D payment flow. It publishes BIN 028918 and PCN MEDDGLP1BR, identifies Humana as the central processor, and requires the beneficiary's MBI.

• Confirm that the beneficiary and product are eligible for the demonstration.
• Use the Bridge route only for the covered program claim, not as a general Part D route.
• The published copay is $50. CMS says the claim has no deductible, does not count toward TrOOP, and does not receive the low-income subsidy.
• Manufacturer coupons and prescription discount programs cannot be applied to the Bridge claim.
• CMS does not allow a manual lost-or-stolen override. A product switch requires a new prior authorization.
• The published pharmacy help desk is 844-673-0910.

Document the route used for the claim

• Record whether the route came from the card, E1 response, payer sheet, or program help desk.
• Keep the source and response date with any route saved to the patient profile.
• Recheck coverage at the plan-year boundary or when the response conflicts with the stored record.
• Use the RX BIN directory for number-first lookup and the routing-field guide for field and reject interpretation.