PRESCRIPTION DRUG COVERAGE

Your Medicare prescription coverage

When you log in to your account, you can check your pharmacy benefits, see medication lists and chat with us about your options.

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See if we cover your drugs

Here's a breakdown of the drug lists and details your plan covers.

2025 Part D Coverage Updates

New this year, we've removed the coverage gap (donut hole) from our Part D coverage. And when you enter the Part D catastrophic coverage stage, your cost is $0. That means you won't pay more than $2,000 for covered Part D drugs in 2025, including any copays or coinsurance.

2025 Part D Coverage Updates

New this year, we've removed the coverage gap (donut hole) from our Part D coverage. And when you enter the Part D catastrophic coverage stage, your cost is $0. That means you won't pay more than $2,000 for covered Part D drugs in 2025, including any copays or coinsurance.

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See pharmacies in your area

We can help you find a pharmacy that's near you and in your network.

UNDERSTANDING MEDICARE PHARMACY COVERAGE
Let’s help you find

We want you to understand your plan's pharmacy benefits, which is why we have a selection of forms that might be useful to you.

How do I find a pharmacy in my network?

You can search for pharmacies by network in the Find Care tool. Either search by the pharmacy’s name and check which networks they’re in, or search for ones near you and filter your results by your network. If you log in to your account first, your search results will automatically list pharmacies in your network. Need more help? Click here to contact us.

What are “preferred” drugs or pharmacies?

Preferred drugs and pharmacies can help you save money. Our doctors and pharmacists create a list of preferred drugs for our list of covered drugs (called a formulary). For the most part, this list is divided into tiers. Lower tiers are usually made up of preferred drugs, which have lower cost shares. You usually save money when you use lower-tier drugs.

Our drug tiers are:

  • Tier 1 - Preferred Generic Drugs (lowest cost-share)
  • Tier 2 - Generic Drugs
  • Tier 3 - Insulin Drugs
  • Tier 3 - Preferred Brand Drugs
  • Tier 4 - Non-Preferred Drugs
  • Tier 5 - Specialty Drugs (highest cost-share)

Some plans include a list of preferred pharmacies that have agreed to keep costs lower for our members. You'll save money if you use them.

 

What is a specialty pharmacy or drug?

A specialty drug is a prescription drug that is given by injection or infusion, sometimes by you and sometimes in the doctor’s office. You’ll often get the best price for your medicine by getting it from certain specialty pharmacies, even if it’s your doctor or preferred facility doing the procedure.

See all questions

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A little Extra Help can go a long way

Prescription coverage is important, but it can also be a big expense. Members who qualify can lower their prescription costs with the Extra Help program through Social Security.

See if you're eligible and how to apply
What qualifies you for Extra Help?

  • You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance)
  • You live in the United States
  • You meet the income and resource limit

What are the income and resource limits?

  • Your income is how much money you make each year.
  • Your resources are things of value that you own, like real estate, bank accounts and investments. Go to Medicare.gov for details on what counts in resources limits.

The income limit is based on your income from the previous year.

Your Status Income Limit Resource Limit
Single $22,590 $17,220
Married couple living together $30,660 $34,360

What are the benefits?

Starting in 2024, all Extra Help beneficiaries will receive full benefits.

Full benefits

  • No monthly premium
  • No deductible
  • Up to $4.50 for each generic drug
  • Up to $11.20 for each brand name drug

In 2024, once your total drug costs (what both you and your plan pay) reach $8000, you’ll pay $0 for each covered drug.


New for 2025, we've removed the coverage gap (donut hole) from our Part D coverage. And when you enter the Part D catastrophic coverage stage, your cost is $0. That means you won't pay more than $2,000 for covered Part D drugs in 2025, including any copays or coinsurance.

How do I apply for Extra Help?

There are three ways to apply.

  1. Apply online at Social Security.
  2. Apply over the phone by calling Social Security at 1-800-772-1213 ,TTY 1-800-325-07781-800-772-1213, TTY 1-800-325-0778. Available in most U.S. time zones Monday – Friday 8 a.m. – 7 p.m. in English and other languages.
  3. Apply in person at your local Social Security Office.

After you apply, Social Security will review your application and send you a letter to let you know if you qualify for Extra Help. And, if you do, you can choose a Medicare Advantage Prescription Drug Plan. If you don't select a plan, the Centers for Medicare & Medicaid Services (CMS) will do it for you. The sooner you join a plan, the sooner you begin receiving benefits.

If you qualify for Extra Help but your plan hasn't been notified by CMS, you can show certain documents to your pharmacy and pay a lower copay.

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Medicare Prescription Payment Plan

New for 2025, you can pay for your prescriptions over time with monthly payments. Click here to learn more. If you're having trouble paying for your prescriptions and you qualify, Social Security's Extra Help program can help lower your prescription payments. If you need help, give us a call at 1-800-831-2583, TTY 711 seven days a week, from 8 a.m. to 9 p.m. ET.

New for 2025, you can pay for your prescriptions over time with monthly payments. Click here to learn more. If you're having trouble paying for your prescriptions and you qualify, Social Security's Extra Help program can help lower your prescription payments. If you need help, give us a call at 1-800-831-2583, TTY 711 seven days a week, from 8 a.m. to 9 p.m. ET.

How do I opt-in or opt-out of the Medicare Prescription Payment Plan program?

You can sign up through your online account or by printing and filling out this PDF. Please see Terms and Conditions for additional information.

If you had an urgent prescription filled that you paid for before we received and processed your enrollment in the Medicare Prescription Payment Plan, you’ll be able to get a retroactive election into the program. You can get a retroactive election if:

  • You think any delay in getting your prescription would harm your life, health or ability to function.
  • You ask for the retroactive enrollment within 72 hours of filling your urgent prescription.

Once you’re enrolled in the plan, we’ll reimburse you for any cost-share you paid for your urgent prescription and any other covered Part D prescription filled between the urgent claim and the date your payment plan started. We’ll reimburse you within 45 days of your enrollment date.

If we determine you didn’t ask for retroactive election within the required timeframe, we’ll let you know and give you instructions on how to file a grievance.

How do I submit a complaint?

Learn more about making a complaint here.