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The Medicare Prescription Drug Plan is a Medicare Part D Plan with expanded prescription coverage. Express Scripts Medicare Prescription Drug Plan (PDP) administers the benefits.

Eligible members will automatically be enrolled in the Express Scripts Medicare PDP with their enrollment in the Medicare Advantage Plan. Non-Medicare-eligible dependents will remain in the Non-Medicare Prescription Drug Plan.

Subscribers will receive a separate prescription ID card upon enrollment. Contact Express Scripts Medicare Customer Service for more information.

How the Medicare Prescription Plan Works

  1. The member receives a prescription from a health care provider.
  2. Fill the prescription at a network pharmacy. Depending on the medication, members have several options in which to fill their prescriptions:
    1. Short-term medications can be filled at a retail pharmacy.
    2. Members taking ongoing, maintenance medications must decide whether they would like to fill it at a retail pharmacy or through ESI’s Medicare Home Delivery. Contact Express Scripts Medicare for more information.
  3. Pay for prescription. Copayments are based on the drug tier (preferred* generic or brand, or non-preferred), the Coverage State level (Initial, Coverage Gap or Catastrophic) and where the prescription was filled (retail pharmacy or home delivery). View the Benefit Chart for more information.
    1. Some prescriptions are covered at 100%. See Preventive Services for more information.
  4. Covered Medicare Part D drugs are available at non-network pharmacies only in special circumstances, such as illness while traveling outside of the plan’s service area where there is no network pharmacy. Members may have to pay additional costs for drugs received at non-network pharmacies.

Additional Plan Information — Members will receive additional plan information directly from Express Scripts Medicare, including a benefit overview, formulary, pharmacy directory and monthly explanations of benefits.

Extra Help Program — People with limited incomes may qualify for Extra Help to pay for their Medicare prescription drug costs. For more information about Extra Help, contact your local Social Security office or call Social Security at 800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 800-325-0778.

*Preferred drug as determined by ESI.

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