Medicare Part D Prescription Drug Coverage 2023

Generations Advantage Prime (HMO POS), Select (LPPO), Value Plus (HMO), and Focus DC (HMO SNP) plans have Part D Prescription Drug coverage built right into the plan. Your prescription coverage is included in your premium. All Prime plan members, Focus DC plan members and Select plan members in Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo, York, Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan counties have no deductibles, so with your very first prescription, you only pay a small copayment or coinsurance. All Value Plus plan members and Select plan members in Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington, Coos, Belknap, Carroll, and Grafton counties, have a $275 deductible for drugs in Tiers 3, 4, and 5. There is no deductible for drugs in Tiers 1 and 2. Copayments/coinsurance are determined by what type of drug you are receiving as well as which pharmacy you choose to use.

Pharmacies with preferred cost sharing*—For a 30-day supply of medication filled at a retail pharmacy with preferred cost sharing* the cost of Preferred Generic (Tier 1) is $0, Generic (Tier 2) is $10, Preferred Brand (Tier 3) is $40, Non-Preferred Drug (Tier 4) is $95. For Specialty Tier (Tier 5) All Prime plan members, Focus DC plan members and Select plan members in Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo, York, Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan counties pay a 33% coinsurance. All Value Plus plan members and Select plan members in Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington, Coos, Belknap, Carroll, and Grafton counties pay a 28% coinsurance.

Pharmacies with standard cost sharing—For a 30-day supply of medication filled at a retail pharmacy with standard cost sharing the cost of Preferred Generic (Tier 1) is $4, Generic (Tier 2) is $18, Preferred Brand (Tier 3) is $47, Non-Preferred Drug (Tier 4) is $100. For Specialty Tier (Tier 5) All Prime plan members, Focus DC plan members and Select plan members in Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo, York, Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan counties pay a 33% coinsurance. All Value Plus plan members and Select plan members in Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington, Coos, Belknap, Carroll, and Grafton counties pay a 28% coinsurance.

For a table showing the pharmacy copayment levels please see the Pharmacy Benefit Copayment Overview page on your plan page.

*Use the Pharmacy Search tool to find a preferred network pharmacy for Martin's Point Generations Advantage plan members with prescription drug coverage.

If you have questions about how much specific medications will cost under your plan, you can search our online drug list or call Member Services at 1-866-544-7504 (TTY: 711), 8 am-8 pm, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.

For more information on coverage determinations, including exceptions, grievances, and appeals processes, please see look at Chapter 9 of the Evidence of Coverage for your plan below:

• Prime (HMO-POS)
• Select (LPPO)
• Value Plus (HMO)
• Focus DC (HMO SNP)

For the Alliance Plan, please see Chapter 7 of the Evidence of Coverage.

• Alliance (HMO) plan