Your Medicare Pharmacy & Prescription Drug Coverage

  Where can I find my drug list?

Your drug list, also called a formulary, is a list of prescription drugs that are covered by your health plan. The drug list shows the most comprehensive drugs on your plan and is regularly updated. You can find your drug list in your secure member portal or on your health plan website.

  What if my drug is not on the drug list?

If you are currently on a drug that is not on your drug list, please check your plan's formulary for details on alternative drugs. Your health plan website also has an Alternative Drugs List with the most common drug alternatives that are covered by your plan.

Talk to your doctor to see if any alternative drugs will work for you.

  How much will I pay for my prescription drugs?

If your plan has a deductible, you will pay the full cost of your medications until your deductible has been met for the year. You will not pay more than $2,100 per year out-of-pocket for your medications. You can use the Estimate Drug Costs tool through your secure member portal to see how much your out-of-pocket expenses may be and see similar drug options.

Medicare places drugs into different cost levels called “tiers.” Plan types may vary in the number of tiers offered.

On most of our plans, you will pay $0 for Tier 1 and Tier 6 medications, and $0 at preferred pharmacies for Tier 2 medications. We offer a wide variety of generic drugs on these tiers and also cover generic erectile dysfunction drugs and select vitamins like folic acid, vitamin B12, and vitamin D2.

Other tiers may have a coinsurance where you pay a percentage of the total drug cost. Your costs can vary depending on the drug and pharmacy that you use.

Learn more about Medication Assistance.

  Does my plan cover shots and vaccines?

Yes, all adult, ACIP-recommended Part D vaccines, such as RSV and Shingles, are available at no cost to you. In addition, your plan also covers Part B vaccines, such as Influenza, Pneumococcal, and COVID-19 at no cost to you.

  Does my plan include insulin?

Yes, you can get a 30-day supply of each covered insulin for $35 or less.

  Why should I use an in-network pharmacy?

You can save on out-of-pocket drug costs by using a preferred, in-network pharmacy.

We have over 60,000 pharmacies in our network with both local and retail pharmacies for you to choose from. Our partnerships with CVS and Walgreens and most grocers ensure that you can find a preferred, in-network pharmacy that is close to you.

Use the Find a Provider Tool in your member portal to find a preferred pharmacy near you.

  Can I have my prescriptions mailed to my home?

You can save time and trips to the pharmacy through Mail Order Pharmacy. Get up to a 90-day supply of your prescription drugs sent to your home with Express Scripts^® Pharmacy. Your prescriptions will be automatically refilled and renewed so you don’t run out of your medication. This service is included with your health plan at no extra cost to you. Plus, standard shipping is free!

Your prescriptions are delivered to your door in discreet packaging. You can track your medication delivery and get updates by email, phone, or text to make sure you have your medications when you need them.

To get started, call Express Scripts at 1-833-750-0201 (TTY 711) 24 hours a day, 7 days a week, or visit express-scripts.com/rx to register.

Learn more about Mail Order Pharmacy.

  What if my medications need prior authorization or pre-approval?

Some medications need prior authorization, or pre-approval, and are noted with a “PA” in your drug list.

If you are prescribed a medication that requires pre-approval, your doctor will need to submit a prior authorization form requesting the drug for you.

  What if I can’t afford my medications?

If you're having a hard time paying for the prescription drugs you need, don’t stop taking your medicine or reducing the amount you take. Taking your medication as prescribed by your doctor helps keep you healthy. Talk to your doctor about your medication options. Your doctor can recommend drugs that may cost less and may work better for you.

Taking a generic drug is one way to save money on your medications and we have over 2,300 generic drugs available. Generic drugs typically cost less than brand name drugs and have the same active ingredients as the brand-name medication. The Food & Drug Administration (FDA) reviews and approves all generic and brand name medications.

Compare brand name, generic and preferred medications that are available to you on your health plan website.

The Medicare Prescription Payment Plan is a new payment option that works with your current drug coverage and can help you manage your drug costs by spreading them across monthly payments that vary throughout the year from January to December. Learn more about Medicare Prescription Payment Plan.