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Prescription Drug & Vaccine Coverage

Explore your plan's Part D Prescription Drug and vaccine benefits—including copays, drug tiers, and coverage phases.

Generations Advantage plans listed below have Part D Prescription Drug coverage built right into the plan. This means your prescription coverage is already included in your premium.

Below you will find coverage information including drug costs and copays, drug tiers, and more.

In addition to prescription drug coverage, members also have vaccine coverage, giving access to many routine vaccines with little or no out-of-pocket cost.

2026 Coverage:
Prime (HMO-POS) | Select (LPPO) | Essential (HMO-POS)

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Drug Coverage Phases Drug Coverage by Plan Insulin Costs Vaccine Coverage


Drug Coverage Phases

   Deductible Phase

For plans with a deductible: The deductible applies to covered drugs in Tiers 3, 4, and 5.

You will pay the full cost for drugs in these tiers until the plan's deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers.

For drugs in Tiers 1, 2, and 6 (for plans who have this tier), you start immediately in the Initial Coverage Phase.

 number two icon  Initial Coverage Phase

You begin this phase when you fill your first prescription of the year and pay set copays or cost shares for covered drugs. Once you reach $2,100, you enter the Catastrophic Coverage Phase.

   Catastrophic Coverage Phase*

Once you have moved into the Catastrophic Coverage phase, you pay $0 for covered drugs for the remainder of the year.

Questions about drug coverage phases?  Download our helpful Drug Coverage Phases Guide [PDF]

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Prescription Drug Coverage by Plan

Part D Prescription Drug coverage for Generations Advantage plan members can be found below, including:

  • Part D deductible information
  • Drug tiers (including generic, preferred, and specialty drugs)
  • Copay information


2026 Plan Year 

Generations Advantage Prime, Select, and Essential

Prime H5591-006-001/002 Plan Members

Maine Counties: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York


Prescription Deductible: $300 

Plan members must meet the $300 Part D deductible for Tiers 3, 4, and 5 drugs before entering the Initial Coverage Phase. Tiers 1, 2, and 6 drugs start in the Initial Coverage Phase immediately.

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $300 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.

Prime H5591-016/017 Plan Members

Maine: Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington


Prescription Deductible: $275

Plan members must meet the $275 Part D deductible for Tiers 3, 4, and 5 drugs before entering the Initial Coverage Phase. Tiers 1, 2, and 6 drugs start in the Initial Coverage Phase immediately.

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $275 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.


Prime | Online Formulary Search Tool
Prime | Complete 2026 Formulary [PDF]

Member Costs in Initial Coverage Phase

Your drug costs depend on what tier your drug is in, what "coverage phase" you are in, when you get the drug, and which pharmacy you use.

Prime H5591-006-001 & H5591-006-002: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties. 

Tier 1: Preferred Generic Tier 2:
Generic		 Tier 3: Preferred Brand Tier 4:
Non-Preferred		 Tier 5: Specialty Tier 6:
Select Care Drug

Pharmacies with Preferred Cost  Sharing (including Hannaford pharmacies) | 30-day supply*

 $0 $5 25% of cost 30% of cost 29% of cost $0

Pharmacies with Preferred Cost Sharing (including Hannaford pharmacies) | 90-day supply*

 $0 $15 25% of cost 30% of cost Not covered $0

Pharmacies with Standard Cost Sharing | 30-day supply*

 $4 $10 25% of cost 32% of cost 29% of cost $4

Pharmacies with Standard Cost Sharing | 90-day supply*

 $12 $30 25% of cost 32% of cost Not covered $12

Mail Order | 30-day supply*

 $0 $10 25% of cost 32% of cost 29% of cost $0

Mail Order | 90-day supply*

 $0 $25 25% of cost 32% of cost Not covered $0



Prime H5591-016 & H5591-017: Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties.

Tier 1: Preferred Generic Tier 2:
Generic		 Tier 3: Preferred Brand Tier 4:
Non-Preferred		 Tier 5: Specialty Tier 6:
Select Care Drug

Pharmacies with Preferred Cost  Sharing (including Hannaford pharmacies) | 30-day supply*

 $0 $0 25% of cost 30% of cost 29% of cost $0

Pharmacies with Preferred Cost Sharing (including Hannaford pharmacies) | 90-day supply*

 $0 $0 25% of cost 30% of cost Not covered $0

Pharmacies with Standard Cost Sharing | 30-day supply*

 $4 $10 25% of cost 32% of cost 29% of cost $4

Pharmacies with Standard Cost Sharing | 90-day supply*

 $12 $30 25% of cost 32% of cost Not covered $12

Mail Order | 30-day supply*

 $0 $10 25% of cost 32% of cost 29% of cost $0

Mail Order | 90-day supply*

 $0 $25 25% of cost 32% of cost Not covered $0

Important Note About Prescription Pricing: In some cases, the cost of a drug is lower than the copay amount of its Tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.

Select H1365-001 Plan Members

Maine Counties: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York


Prescription Deductible: $300 

Plan members must meet the $300 Part D deductible for Tiers 3, 4, and 5 drugs before entering the Initial Coverage Phase. Tiers 1, 2, and 6 drugs start in the Initial Coverage Phase immediately.

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $300 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.

Select H1365-005 Plan Members

Maine: Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington


Prescription Deductible: $450

Plan members must meet the $450 Part D deductible for Tiers 3, 4, and 5 drugs before entering the Initial Coverage Phase. Tiers 1, 2, and 6 drugs start in the Initial Coverage Phase immediately.

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $450 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.


Select | Online Formulary Search Tool
Select | Complete 2026 Formulary [PDF]

Member Costs in Initial Coverage Phase

Your drug costs depend on what tier your drug is in, what "coverage phase" you are in, when you get the drug, and which pharmacy you use. 

Select H1365-001: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties.

Tier 1: Preferred Generic Tier 2:
Generic		 Tier 3: Preferred Brand Tier 4:
Non-Preferred		 Tier 5: Specialty Tier 6:
Select Care Drug

Pharmacies with Preferred Cost  Sharing (including Hannaford pharmacies) | 30-day supply*

 $0 $5 25% of cost 30% of cost 29% of cost $0

Pharmacies with Preferred Cost Sharing (including Hannaford pharmacies) | 90-day supply*

 $0 $15 25% of cost 30% of cost Not covered $0

Pharmacies with Standard Cost Sharing | 30-day supply*

 $4 $10 25% of cost 32% of cost 29% of cost $4

Pharmacies with Standard Cost Sharing | 90-day supply*

 $12 $30 25% of cost 32% of cost Not covered $12

Mail Order | 30-day supply*

 $0 $10 25% of cost 32% of cost 29% of cost $0

Mail Order | 90-day supply*

 $0 $25 25% of cost 32% of cost Not covered $0


Select H1365-005: Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties.

Tier 1: Preferred Generic Tier 2:
Generic		 Tier 3: Preferred Brand Tier 4:
Non-Preferred		 Tier 5: Specialty Tier 6:
Select Care Drug

Pharmacies with Preferred Cost  Sharing (including Hannaford pharmacies) | 30-day supply*

 $0 $0 25% of cost 30% of cost 27% of cost $0

Pharmacies with Preferred Cost Sharing (including Hannaford pharmacies) | 90-day supply*

 $0 $0 25% of cost 30% of cost Not covered $0

Pharmacies with Standard Cost Sharing | 30-day supply*

 $4 $10 25% of cost 32% of cost 27% of cost $4

Pharmacies with Standard Cost Sharing | 90-day supply*

 $12 $30 25% of cost 32% of cost Not covered $12

Mail Order | 30-day supply*

 $0 $10 25% of cost 32% of cost 27% of cost $0

Mail Order | 90-day supply*

 $0 $25 25% of cost 32% of cost Not covered $0

Important Note About Prescription Pricing: In some cases, the cost of a drug is lower than the copay amount of its Tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.

All Maine Counties


Prescription Deductible: $300

Plan members must meet the $300 Part D deductible for Tiers 3, 4, and 5 drugs before entering the Initial Coverage Phase. Tiers 1, 2, and 6 drugs start in the Initial Coverage Phase immediately.

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $300 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.

Essential | Online Formulary Search Tool
Essential | Complete 2026 Formulary [PDF]

Member Costs in Initial Coverage Phase

Your drug costs depend on what tier your drug is in, what "coverage phase" you are in, when you get the drug, and which pharmacy you use. 

Tier 1: Preferred Generic Tier 2:
Generic		 Tier 3: Preferred Brand Tier 4:
Non-Preferred		 Tier 5: Specialty Tier 6:
Select Care Drug

Pharmacies with Preferred Cost  Sharing (including Hannaford pharmacies) | 30-day supply*

 $0 $0 25% of cost 30% of cost 29% of cost Not covered

Pharmacies with Preferred Cost Sharing (including Hannaford pharmacies) | 90-day supply*

 $0 $0 25% of cost 30% of cost Not covered Not covered

Pharmacies with Standard Cost Sharing | 30-day supply*

 $4 $10 25% of cost 32% of cost 29% of cost Not covered

Pharmacies with Standard Cost Sharing | 90-day supply*

 $12 $30 25% of cost 32% of cost Not covered Not covered

Mail Order | 30-day supply*

 $4 $10 25% of cost 32% of cost 29% of cost Not covered

Mail Order | 90-day supply*

 $0 $25 25% of cost 32% of cost Not covered Not covered

Important Note About Prescription Pricing: In some cases, the cost of a drug is lower than the copay amount of its Tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.

*Different cost-sharing applies for members who receive "Extra Help" (Low-Income Subsidy (LIS/LICS))

**For Tier 1 and Tier 6 medications (for applicable plans), members may obtain up to a 100-day supply for a $0 copay at preferred retail and CVS Caremark Mail Service pharmacies (for standard pharmacies, members will pay the 90-day standard copay for 100-day supply).


Insulin Costs and Vaccine Coverage 

Part D insulin coverage and costs

These prices apply to all plans with Part D coverage.

What You Pay for Part D Insulin

You won’t pay more than $35 for a one-month supply of each insulin product covered under your Part D Prescription Drug benefit, no matter what cost-sharing tier it’s on, even if you haven’t paid any applicable deductible.

Insulin Supply & Copay Summary

30-Day Supply  |  $35 or 25% of cost

60-Day Supply  |  $70 or 25% of cost

90-Day Supply  |  $105 or 25% of cost

Note: Plan members pay the lesser of the two costs.

Part D vaccine coverage and costs

Generations Advantage plans that include Part D Prescription Drug coverage now cover most Part D vaccines at no cost to you even if you haven’t paid any applicable Part D deductible your plan may have. Several routine vaccines are available to all Generations Advantage plan members at little or no cost. Below is an overview of the cost and prescription requirements for several vaccines.

Vaccine cost and prescription requirements vary depending on where you receive the vaccine (at your doctor's office or at your local pharmacy). Please note that some vaccines are covered under your Medicare Part B (medical) benefit.

Vaccine Name / Type Cost at a Doctor's Office* Cost at a Pharmacy

COVID-19—Medicare Part B

All COVID-19 vaccines

You pay $0.

You pay $0.

Flu (Influenza)—Medicare Part B

Quadrivalent, Trivalent, Interdermal, or High Dose

You pay $0.

You pay $0.

Pneumonia—Medicare Part B

Prevnar 13, Prevnar 20, or Pneumovax

You pay $0.

You pay $0 (prescription required).

Shingles—Medicare Part D

Shingrix

You may have to pay full cost and submit for reimbursement. Two shots and two reimbursements are required.

You pay $0 (prescription required).

TDAP—Medicare Part D

Adacel or Boostrix

You may have to pay full cost and submit to plan for reimbursement.

You pay $0 (prescription required).

IMPORTANT: Before any tetanus vaccine, your doctor or pharmacist must call CVS Caremark for coverage determination.

Tetanus—Medicare Part D

Preventive only

You may have to pay full cost and submit to plan for reimbursement. Coverage determination required.

You pay $0 (prescription required).

Tetanus—Medicare Part B

Treatment of wound

You pay 20% of the cost.

Not available at a pharmacy.

NOTE: Vaccine coverage is in accordance with the Inflation Reduction Act of 2022, as of January 1, 2023.

*You will also pay any applicable office visit copay when you get your vaccine from your doctor.

 

 

Need help? We're here for you.

Whether you’re exploring plan options or already a Generations Advantage member, our team is ready to help.

Prospective Members: Call us at 1-800-961-4572 (TTY: 711)
Current Members: Call Member Services at 1-866-544-7504 (TTY: 711)

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