Strengthening the future for CDPHP brokers and employer groups

CDPHP is merging with Excellus Health Plan, Inc., which currently manages health plans across 39 counties in central and western New York. When the merger is finalized, CDPHP will join Excellus Health Plan, Inc. as an additional not-for-profit health plan serving the Capital Region and surrounding areas.

The proposed merger is planned for early 2027.

Since affiliating with this new organization, we were able to integrate our people, systems, and vendors. Many employees and systems are already combined, leading to faster processes and easier experiences both internally and externally.

Our teams officially filed for merger in late 2025 and anticipate state approval within the next year.

We’re excited to team up with another company and expand our capabilities while preserving what makes CDPHP special: local roots, award-winning service, and high-quality coverage. CDPHP will still have:

• Local leadership
• Local, award-winning customer service
• Local account management team
• In-house pharmacy program
• In-house care management program
• A CDPHP network of more than 1 MILLION providers coast to coast*
• Member-friendly tools for cost transparency, locating providers, and more

*Applies to commercial plans with a national network only.

 Any changes or enhancements are intentionally being made to unlock greater buying power, allow us to introduce new products and services, and strengthen the quality and affordability of care

While many CDPHP programs, benefits, and processes are staying the same, we are adjusting others to better serve you. Notable changes will be shared with you throughout the year, some of which include:

• Broker/Group tool enhancements, reporting platforms, the electronic enrollment process, and portals (applies to commercial plans only)
• Pharmacy benefits, including a new pharmacy benefit manager, a stronger pharmacy network, and improved pricing tools
• New member ID cards with one phone number for pharmacy and medical benefits
• A member Monthly Health Summary replacing traditional explanation of benefits (EOBs)
• A new CDPHP.com online experience
• Updates to our medical cost comparison tool
• And much more

• Seamless System Integration:
  • We’ve made significant progress with the migration of CDPHP to Excellus Health Plan, Inc. systems, allowing key business processes, including enrollment and billing, provider registry, credentialing, appeals, and more, to be connected through one common platform.
  • Like CDPHP, our new parent company also uses the Facets system, so there is minimal member disruption in this area.
  • While much of this is “behind the scenes,” our accomplishments internally will set us up for success to provide you with a positive experience externally.
• Advancing Provider Partnerships and Care Delivery Models: CDPHP has long championed the development of an integrated care delivery system in upstate New York. To help further that mission, Dr. Martin Stallone was appointed as Executive Vice President, Chief Healthcare Services Officer of CDPHP and our parent company, The Lifetime Healthcare Companies (LTHC), to focus on enhancing provider partnerships across Upstate New York.
• More High Ratings: CDPHP continues to be one of the highest rated commercial and Medicare health plans in the nation, according to NCQA’s Commercial Health Plan Ratings 2025 and the Centers for Medicare & Medicaid Services Star Ratings program!

Our pharmacy program will continue to be managed by a team of local and regional, experienced pharmacists and health care experts, ensuring we have the best programs and partners in place. Together, our teams deliver smarter pricing, broader access, and innovative programs that proactively improve outcomes and lower total cost of care.

However, it’s time to evolve our pharmacy offerings based on market needs. Soaring prescription drug costs and volatility in drug pricing models require stability and the right long-term partners for us to provide the best coverage at the lowest price. By working with Excellus Health Plan, Inc. in this area, CDPHP can build on proven models while maintaining our in-house program, local focus, and hands-on service.

While a few legacy programs are retiring, we are replacing them with stronger, more intentional solutions. These powerful, clinically guided programs—with proven results—position CDPHP to deliver a more sustainable pharmacy experience and better health outcomes for the communities we proudly serve.

Some pharmacy program enhancements that will happen in 2027 include:

• New pharmacy benefit manager (PBM): Express Scripts® Pharmacy Benefit Services (ESI) will be the new CDPHP PBM. Capital Rx was the right solution years ago, and ESI is the right solution for where pharmacy is going next. Aligning with a national PBM strengthens our ability to manage rising costs, respond to market trends, and expand the solutions available to our members and employer groups.
• Stronger pharmacy network: Fully insured commercial and self-funded groups with pharmacy benefits administered by CDPHP will gain a stronger pharmacy network with a standard cost share model across all participating pharmacies, including CVS retail pharmacies. Standard cost share model means member pharmacy costs, like copays or coinsurance, are based on their health plan structure, instead of a preferred vs. non-preferred pharmacy network structure. This change expands members’ access to pharmacies and gives them more freedom of choice. Please note: 2027 plan-year updates for CDPHP Medicare Advantage (MA) are still in review. In line with prior years, we will update you on MA plan benefits once finalized with CMS.
• Easier prescription drug shopping: Members will have access to real-time drug pricing through a new price check tool (replacing CDPHP ConnectRx, On the Go), making it easy to find the best drug at the best price.
• Additional mail order options: Members will continue to have access to Wegmans Mail Order, plus ConnectRx pharmacy and Express Scripts.
• More details about these pharmacy changes will be shared in the coming months.

Group structure updates will be implemented for commercial, self-funded, and Medicare groups effective January 1, 2027.

Updates will include:

• A new group ID for every commercial, self-funded, and Medicare group.
• A new member ID for every commercial, self-funded, and group Medicare member.
• Separate group IDs for medical and dental products.
• A standardized subgroup and class ID structure for more cohesive reporting and billing.
• A separate invoice for each subgroup (groups will be billed at the subgroup level with enhanced billing capabilities).

CDPHP will provide the new group, subgroup, and class IDs to each group in advance.

New ID cards will be issued to members beginning November 2026.

More details about these updates will be communicated to employer groups and members in a timely fashion throughout 2026.

As part of planned merger with Excellus Health Plan, Inc., CDPHP will transition to an in-house platform for electronic enrollment and maintenance effective January 1, 2027.

This only impacts groups that use EDI for enrollment. The change applies to all groups on January 1, 2027, regardless of renewal date.

Benefitfocus will continue processing all files with 2026 effective dates through December 31, 2026.

Each CDPHP employer group 834 file will be sent to an in-house platform for effective dates beginning January 1, 2027.

CDPHP will help with the transition by assigning a CDPHP implementation analyst to each employer group and/or electronic enrollment file submitter to help:

• Provide new SFTP requirements
• Provide a new 2027 companion guide and account structure
• Complete testing and provide approval for production
• Answer questions and troubleshoot issues

CDPHP will begin making outreach to impacted groups/submitters in April 2026.

More details about these updates will be communicated to employer groups in a timely fashion throughout 2026.

Welvie My Surgery: Digital decision-support program that helps members prepare for surgery by guiding them through treatment options, risks, and questions to ask their doctor (self-funded add on).

Maternity care program: A maternity and NICU support program that gives expectant and new parents education and guidance to promote healthy pregnancies at no cost for fully insured groups (self-funded add on).

Vori Health: Virtual musculoskeletal health care and physical therapy services to diagnose, treat, and manage pain in the back, neck, and joints at no cost for fully insured groups (self-funded add on upon renewal).

Wellframe: Digital care management app that delivers personalized care plans, education, and messaging at no cost for all groups to help members stay engaged in their care.

24/7 Nurse Line: 24/7 phone access to registered nurses for education and support at no cost for all groups.

Healthwise: Evidence-based health education materials on the CDPHP website and online member accounts. Available to all groups at no cost.

Expanded provider network: Upon merger, members can use the CDPHP network providers they know and trust, plus those contracted directly with Excellus Health Plan, Inc.

CDPHP Vision will offer an expanded vision network (small and large groups 1/1/27, coming later for self-funded).

For more information on how these benefits will apply to your plan, check out the fully insured and self-funded tip sheets.

CDPHP Medicare Advantage updates for 2027 are pending. As in prior years, updates will be available once finalized with the Centers for Medicare and Medicaid Services (CMS). Benefit updates subject to change based on contract executions.

TruHearing will move to DME cost share upon renewal for fully insured groups (embedded for small group, add on for large group and self-funded).

The Embrace Health Flex Card will transition from NationsBenefits to Lifetime Benefits Solutions.

Estimate Medical Costs will replace CDPHP Price Check and will be integrated with the provider search tool, allowing members to search for doctors and compare prices at the same time.

MD Live Virtual Care will replace Doctor On Demand and will include teledermatology.

Transform for Prediabetes will sunset after 2026. For 2027, members will have access to diabetes and pre-diabetes tools through the Wellframe app, as well as access to diabetes care managers through the Diabetes Management Program.

For more information on how these benefits will apply to your plan, check out the fully insured and self-funded tip sheets.

CDPHP Medicare Advantage updates for 2027 are pending. As in prior years, updates will be available once finalized with the Centers for Medicare and Medicaid Services (CMS). Benefit updates subject to change based on contract executions.

Plan designs (community rated small group cost share may be modified to align with New York state actuarial value).

Reimbursements including for fitness, weight management, doula, parenting preparation, dental, vision hardware, LASIK, and Ciccotti Center MyFitRx and Kids on the Move.

Ovia Health cycle tracking, pregnancy, parenting, and menopause app. 

Dental benefits from Delta Dental.

Virtual mental health from Valera Health and aptihealth.

CDPHP Health Hub digital wellness platform.

For more information on how these benefits will apply to your plan, check out the fully insured and self-funded tip sheets.

CDPHP Medicare Advantage updates for 2027 are pending. As in prior years, updates will be available once finalized with the Centers for Medicare and Medicaid Services (CMS). Benefit updates subject to change based on contract executions.

Aligning with ESI strengthens our ability to manage rising costs, respond to market trends, and expand the solutions available to members in 2027 by combining national scale with local and regional expertise. CDPHP members will have access to a wide variety of clinically integrated pharmacy programs aimed to:

• Enhance member experience
• Improve quality of care
• Increase cost savings

These programs will continue to be managed in-house by the experienced, local CDPHP Care Management and Clinical Pharmacy teams collaborating in real time to provide coordinated, personalized support that members can trust.

Fully insured commercial and self-funded groups with pharmacy benefits administered by CDPHP will gain a stronger pharmacy network with a standard cost share model across all participating pharmacies, including CVS retail pharmacies. Standard cost share means members’ pharmacy costs, like copays or coinsurance, are based on their health plan structure, instead of a preferred vs. non-preferred pharmacy network structure. This change expands our members’ access to pharmacies and gives them more freedom of choice.

(Legacy programs sunsetting on December 31, 2026, include CDPHP Preferred Rx Network and CDPHP Rx for Less prescription discount program.)

Please note: 2027 plan-year updates for CDPHP Medicare Advantage are still in review. In line with prior years, we will update you on MA plan benefits once finalized with CMS.

Members will have easier access to real-time pricing for prescription drugs and more through the new Check Drug Prices tool accessible via their CDPHP online member account. This streamlined digital experience will make it easier for more members to save money and get the most out of their pharmacy benefits.

With one simple login, members will be able to:

• Check drug prices in real time
• Find a retail, home delivery, or specialty pharmacy
• Access prescription claim history
• Get non-emergent online support from health plan pharmacists

(This replaces CDPHP ConnectRx, On the Go which will sunset on December 31, 2026. App users will be notified by CDPHP in Q4 2026.)

In 2027, CDPHP will offer more mail order pharmacy options, providing members with greater access to cost-savings and convenience. Members with mail order benefits will be able to choose from three options based on their unique needs and preferences:

• Wegmans Home Delivery
• Express Scripts^® Pharmacy
• ConnectRx pharmacy, powered by CDPHP

(Costco Mail Order Pharmacy will be out of network January 1, 2027. Approximately 1,000 members currently using this service will be notified in Q3 2026 with details about the transition to a new mail order provider.)