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Have a new prescription?

Posted 05/02/25

Feel confident about your coverage with these tips.

If your Generations Advantage plan includes Part D Prescription Drug benefits, it can be helpful to understand some basics about your coverage to help avoid surprises at the pharmacy. Our guide can help you know what to expect when picking up a new prescription. Here are three important fundamentals to start with:

1.) Medicare Part D covers prescription drugs you normally fill at a pharmacy.

2.) Your plan has a list of drugs that are covered under your Part D benefit. This list is called a “formulary.”

3.) Your costs for Part D-covered drugs are determined by three things:

a. Which “Part D coverage phase” you are in

b. Which “tier” your drug falls into—think of tiers as “cost categories”

c. Which pharmacy you use to fill your prescriptions

Visit our Prescription Drug & Vaccine Coverage page to learn more about how your costs are figured.

What to know BEFORE heading to the Pharmacy

Whenever you’re prescribed a new medication, it’s always a good idea to check your plan’s formulary (list of covered drugs) to understand if the medication is covered, what you can expect for cost, and if there are any special requirements for coverage. We’ll explain how to check your plan’s formulary below, but first, here are some types of medications that are normally excluded from Medicare Part D coverage:

Medications typically NOT COVERED by your Part D benefit

» Medications used for weight loss or gain (e.g., Zepbound, Contrave, phentermine, Saxenda)

» Medications used for erectile dysfunction (ED) (e.g., sildenafil (Viagra), tadalafil (Cialis))

» Medications used for cosmetic purposes (e.g., Propecia^®, Vaniqa cream)

» Fertility medications (e.g., Follistim, Gonal-F)

» Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)

» Over-the-counter (OTC) medications or non-prescription drugs

To check if your prescribed medication is on your Generations Advantage plan’s formulary (list of covered drugs):

Use the online tools or PDF formulary documents below to check if your medication is covered under your plan:

» Search for your medications with our online tool.

» View a complete list of covered drugs: See a PDF of your plan’s formulary or call Member Services at 1-866-544-7504 (TTY: 711).

If your prescription IS on your plan’s formulary, you will find the medication name and strength, the drug tier (cost category), and if there is any quantity limit and/or prior authorization required:

» Find the tier and corresponding copays for your specific plan and pharmacy on our Drug and Vaccine Coverage page.

NOTE: Generations Advantage Select, Value Plus, and Access plans have a Part D Deductible Phase. In this phase, a deductible must be met for drugs in certain tiers before entering the Initial Coverage Phase for those drugs.

If your prescription is NOT on the formulary

If your prescription is not on your plan’s Part D formulary, you can expect the pharmacy to receive a rejected claim and the medication not to be covered.

If this happens, here are some options for next steps:

» The medication may be available over the counter (OTC). If so, you may be able to purchase it using your Generations Advantage CVS OTC benefit. Visit our OTC Benefit page to browse the catalog of eligible items, find your OTC quarterly allowance amount, and learn how to purchase.

» If not available over the counter, ask your local pharmacist for recommendations on any savings programs for the specific medication.

» Talk to your provider about switching to a “formulary alternative”— a medication on the formulary which may work similarly to the nonformulary medication.

» If you are unable to use a formulary alternative, you or your provider can request a “formulary exception.” Call Member Services at 1-866-544-7504 (TTY: 711) to learn more. You can also contact CVS Caremark—our trusted partner for prescription and Part D services—at 855-344-0930 (TTY: 711) to discuss next steps for requesting an exception.

The formulary search tool may be able to help with identifying alternatives on the formulary:

For more information about your Part D Prescription Drug benefit, visit our Pharmacy and Prescription Resources page. You’ll find:

» Details on coverage for prescriptions and vaccines

» Plan formularies and the formulary search tool

» Coverage determinations and appeals information

» How to get financial help to cover Part D costs

» And much more

As always, we’re here to help.

We hope this information and these tools help keep you informed about your Part D Prescription Drug coverage. If you have any questions, don’t hesitate to call Member Services at 1-866-544-7504 (TTY: 711). We’re available 8am-8pm, every day from Oct. 1-Mar. 31 and weekdays from Apr. 1-Sep. 30.