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Medicare Prescription Drug Plan
Medicare-Eligible Members
MCHCP offers the Express Scripts Medicare Prescription Drug Plan (PDP) for your prescription drug coverage.
The Express Scripts Medicare PDP is a Medicare Part D plan with expanded prescription coverage for some non-Part D drugs. You will have access to Express Scripts’ network of pharmacies to fill your prescriptions. You must use the Medicare PDP network pharmacies. Covered Medicare Part D drugs are available at non-network pharmacies only in very special circumstances, such as illness while traveling where there is no network pharmacy. You may have to pay more for drugs received at nonnetwork pharmacies, so it is important to use a network pharmacy whenever possible.
The PDP has a broad choice of covered drugs through the formulary. The Medicare PDP formulary is a list of covered FDA-approved generic and brand-name prescription drugs. Express Scripts places covered drugs into three levels: preferred generic, preferred brand and non-preferred. Preferred drugs are covered at a lower cost to you.
Members can fill a prescription at a network pharmacy or through home delivery, and may receive up to a 90-day supply of certain maintenance drugs. The home delivery benefit covers up to a 90-day supply for 2 1/2 copayments.
Medicare members pay the applicable copayment or the cost of the drug, whichever is less, in the Initial Coverage Stage.
| Stage |
Tier |
Retail 31-Day Supply |
Retail 60-Day Supply |
Retail 90-Day Supply |
Home Delivery 90-Day Supply |
| Initial Coverage Stage |
Tier 1 Preferred Generic Drugs |
$10 copayment |
$20 copayment |
$30 copayment |
$25 copayment |
| Initial Coverage Stage |
Tier 2 Preferred Brand Drugs |
$40 copayment |
$80 copayment |
$120 copayment |
$100 copayment |
| Initial Coverage Stage |
Tier 3 Non-Preferred Drugs |
$100 copayment |
$200 copayment |
$300 copayment |
$250 copayment |
| Catastrophic Coverage Stage |
After annual out-of-pocket drug costs reach $2,100, members will have $0 cost-share.
Amounts paid for non-Part D drugs covered under this plan will not count toward annual out-of-pocket drug costs and you will continue to pay a copayment.
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