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  • Plans & Benefits

Prescription Drug & Vaccine Coverage

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

Generations Advantage Prime (HMO-POS), Select (LPPO), Value Plus (HMO-POS), and Access (LPPO) plans have Part D Prescription Drug coverage built right into the plan. Your prescription coverage is included in your premium. 

Below you will find your plan's coverage information including drug costs and copays, drug tiers, and more.

In addition to prescription drug coverage, plan members also have vaccine coverage. This benefit gives members access to many routine vaccines with little or no out-of-pocket costs. 

Part D Benefit Guide

For a comprehensive look at your plan's Part D prescription drug coverage, explore the Part D Benefit Guide [PDF].


Already a member?

To review personalized Part D benefit and coverage information tailored to you, sign in to your member portal account.

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.

   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 $2,000, 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.

Prescription Drug Coverage by Plan

Part D Prescription Drug coverage for Prime, Select, Value Plus, and Access plan members can be found below, including:

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

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. 


Prescription Deductible: $0 
Member Costs in Initial Coverage Phase

 

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 $10 $42 $95 33% of cost  $0 
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $30 $126 $285 Not Covered $0
Pharmacies with standard cost sharing, 30-day supply*  $4 $18 $47 $100 33% of cost $4
Pharmacies with standard cost sharing, 90-day supply* $12 $54 $141 $300 Not Covered $12
Mail order, 90-day supply*  $10 $45 $117.50 $250 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.

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.


Prescription Deductible: $275 

Select (LPPO) 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.

Member Costs in Initial Coverage Phase

 

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 $42 $95 29% of cost  $0 
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $0 $126 $285 Not Covered $0
Pharmacies with standard cost sharing, 30-day supply*  $4 $10 $47 $100 29% of cost $4
Pharmacies with standard cost sharing, 90-day supply* $12 $30 $141 $300 Not Covered $12
Mail order, 90-day supply*  $10 $25 $117.50 $250 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.

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. 


Prescription Deductible: $150

Value Plus (HMO-POS) plan members must meet the $150 Part D deductible for Tiers 3, 4, and 5 drugs before entering the Initial Coverage Phase. Tiers 1 and 2 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 $150 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1 and 2, you start immediately in the Initial Coverage Phase. The Value Plus plan does not include coverage for Tier 6 drugs.

Member Costs in Initial Coverage Phase

 

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 $42 $95 31% of cost  Not Covered
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $0 $126 $285 Not Covered Not Covered
Pharmacies with standard cost sharing, 30-day supply*  $4 $10 $47 $100 31% of cost Not Covered
Pharmacies with standard cost sharing, 90-day supply* $12 $30 $141 $300 Not Covered Not Covered
Mail order, 90-day supply*  $10 $25 $117.50 $250 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.

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. 


Prescription Deductible: $200

Access Plan (LPPO) members must meet the $200 Part D deductible for Tiers 3, 4, and 5 drugs before entering the Initial Coverage Phase. Tiers 1 and 2 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 $200 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1 and 2, you start immediately in the Initial Coverage Phase.

Member Costs in Initial Coverage Phase

 

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 20% of cost 40% of cost 30% of cost  Not Covered
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $0 20% of cost 40% of cost Not Covered  Not Covered
Pharmacies with standard cost sharing, 30-day supply*  $4 $10 25% of cost 45% of cost 30% of cost  Not Covered
Pharmacies with standard cost sharing, 90-day supply* $12 $30 25% of cost 45% of cost Not Covered  Not Covered
Mail order, 90-day supply*  $10 $25 25% of cost 45% 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))

**Tier 6 copays in this phase are $0 for 30- and 90-day supplies at preferred retail and mail-order pharmacies, and 15% coinsurance at standard retail pharmacies. Additionally, plan costs from all phases ARE NOT COUNTED in the Coverage Gap Phase.


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

60-Day Supply  |  $70

90-Day Supply  |  $105

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

Your Cost at a
Doctor's Office*

Your Cost at a
Pharmacy
COVID-19
Medicare Part B		 All COVID-19 vaccines Medicare covers COVID-19 vaccines for members with no out-of-pocket costs. Visit your state's CDC website for vaccine locations.
Flu (Influenza)
Medicare Part B		 Quadrivalent
Trivalent
Intradermal
High Dose		  You pay $0 for this vaccine.
Pneumonia
Medicare Part B		 Pneumovax
Prevnar 13
Prevnar 20		 You pay $0 for this vaccine.

You pay $0 for this vaccine.

NOTE: You must bring a prescription to the pharmacy
Shingles
Medicare Part D		  Shingrix

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

Shingrix requires two shots and two payments/reimbursements.

You pay $0 for this vaccine.

NOTE: You must bring a prescription to the pharmacy
TDAP
Medicare Part D		  Adacel
Boostrix		  You may have to pay full cost and submit to plan for reimbursement for vaccine.

You pay $0 for this vaccine.

NOTE: You must bring a prescription to the pharmacy

IMPORTANT: Before you get any tetanus vaccine, your doctor or pharmacist must call CVS Caremark for coverage determination.
Tetanus
Medicare Part D
 Preventative only.  You may have to pay full cost and submit to plan for reimbursement for vaccine. Coverage determination is required for reimbursement. 

You pay $0  for this vaccine - coverage determination is required.

NOTE: You must bring a prescription to the pharmacy
Tetanus
Medicare Part B		 Treatment of wound.  You pay 20% of the cost of the vaccine.  Not available at a pharmacy.

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

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

 

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)