Pharmacy and Prescription Resources 2023

2023 Formulary (List of Covered Drugs)

Generations Advantage Prime (HMO POS), Select (LPPO), Focus DC (HMO SNP), and Value Plus (HMO) plans have Part D Prescription Drug coverage built right into the plan. Your prescription coverage is included in your premium. Below you will find links to the formulary (list of covered drugs) for each plan.

  • Prime Plan
    • For Prime, there are no deductibles to meet. With your very first prescription, you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use.
    • Important Message About What You Pay for Vaccines – For plans with no deductible, our plan covers most Part D vaccines at no cost to you. For plans that have a deductible, our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible.
    • Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

  • Select Plan
    • Select plan members in Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo, York, Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, Sullivan counties, there are no deductibles to meet. With your very first prescription, you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use.
    • Select plan members in Aroostook, Hancock, Kennebec, Penobscot, Piscataquis, Somerset, Washington, Coos, Belknap, Carroll, and Grafton counties, you 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.
    • Important Message About What You Pay for Vaccines – For plans with no deductible, our plan covers most Part D vaccines at no cost to you. For plans that have a deductible, our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible.
    • Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

  • Value Plus Plan
    • Value Plus has a $275 deductible for Tiers 3, 4 and 5 medications. There is no deductible for Tiers 1 and 2 medications; you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use. For Tiers 3, 4 and 5, you pay the full cost of the drug until you reach your deductible.
    • Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible.
    • Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

  • Focus DC Plan
    • For Focus DC, there are no deductibles to meet. With your very first prescription, you only pay a small copayment or coinsurance. The copayment/coinsurance is determined by what type of drug you are receiving as well as which pharmacy you use. 
    • Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you.
    • Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.

     

    Call our Member Services team for more information regarding vaccines and insulin: 1-866-544-7504 (TTY: 711)

    Part D Coverage Phases (PDF)

    Our Preferred Pharmacies

    Martin's Point Generations Advantage is happy to offer a network of pharmacies with preferred cost sharing. These include:

    • Hannaford Pharmacies
    • CVS Pharmacies

    We also have a network of local pharmacies with preferred cost sharing. These include:

    Maine

    • Community Pharmacies
    • Herbert Rexall Pharmacy, Van Buren
    • Miller Drug, State Street, Riverside, and Westgate, Bangor, Brewer
    • St. John Valley Pharmacy, Fort Kent
    • Unity Pharmacy
    • Western Maine Pharmacy, Kingfield
    • Wilson’s Drug Store, Bath

     

    New Hampshire

    • The Medicine Store, Concord
    • Roberts Scarlett Pharmacy, New London

    Generations Advantage members receive most medications at lower copays than at pharmacies with standard cost sharing. For full details, visit our Pharmacy and Out-of-Network Coverage Page.



    Additional Prescription Information

    Coverage Determination and Exceptions Process

    Coverage Limits and Extra Help

    Medicare Part D Prescription Drug Coverage

    Medication Therapy Management

    Medication Transition Process

    Pharmacies and Out-of-Network Coverage

    Prescription Utilization Management