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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)

2027 Coverage:
Prime (HMO) | Select (PPO) | Essential (HMO)

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To review personalized Part D benefit and coverage information tailored to you, sign in to your member 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 $2,100 (or $2,400 for the 2027 plan year), 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 guide to learn moure about your coverage and costs:

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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

For a comprehensive look at your plan’s Part D prescription drug coverage, explore the benefit guide below:

2027 Plan Year 

Generations Advantage Prime, Select, and Essential

2027 Prime (HMO) Plan

Prime Plan Drug Formulary
 Find out coverage and cost information for a specific medication or explore all covered drugs:

Prescription Deductible: $500

Applies to all Prime plans
Excludes Tier 1, Tier 2, and Tier 6 drugs

Plan members must meet the 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. Learn More


Drug Copay Costs

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

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.



Martin's Point star iconPrime H5591-017 | Aroostook, Franklin, Knox, Lincoln, Oxford, Penobscot, and Waldo counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost
Tier 4 | Non-Preferred Drug 33% of cost 33% of cost 33% of cost 33% of cost 33% of cost 33% of cost
Tier 5 | Specialty Tier 28% of cost NCB 28% of cost NCB 28% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0

 


Martin's Point star iconPrime H5591-021 & H5591-022 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $5 $15 $10 $30 $10 $25
Tier 3 | Preferred Brand 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost
Tier 4 | Non-Preferred Drug 29% of cost 29% of cost 29% of cost 29% of cost 29% of cost 29% of cost
Tier 5 | Specialty Tier 28% of cost NCB 28% of cost NCB 28% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0
2027 Select (PPO) Plan

Select Plan Drug Formulary
 Find out coverage and cost information for a specific medication or explore all covered drugs:

Prescription Deductible

Excludes Tier 1, Tier 2, and Tier 6 drugs

  • Select H1365-006: $600 | Aroostook, Franklin, Knox, Lincoln, Oxford, Penobscot, and Waldo counties
  • Select H1365-007: $500 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties

Plan members must meet the 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. Learn More


Drug Copay Costs

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

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.


Martin's Point star iconSelect H1365-006 | Aroostook, Franklin, Knox, Lincoln, Oxford, Penobscot, and Waldo counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost
Tier 4 | Non-Preferred Drug 29% of cost 29% of cost 29% of cost 29% of cost 29% of cost 29% of cost
Tier 5 | Specialty Tier 26% of cost NCB 26% of cost NCB 26% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0

 


Martin's Point star iconSelect H1365-007 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $5 $15 $10 $30 $10 $25
Tier 3 | Preferred Brand 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost
Tier 4 | Non-Preferred Drug 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 5 | Specialty Tier 28% of cost NCB 28% of cost NCB 28% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0
2027 Essential (HMO) Plan

Essential Plan Drug Formulary
 Find out coverage and cost information for a specific medication or explore all covered drugs:

Prescription Deductible

Excludes Tier 1 and Tier 2 drugs

  • Essential H5591-018: $300 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties
  • Essential H5591-019: $175 | Aroostook, Franklin, Knox, Lincoln, Oxford, Penobscot, and Waldo counties
  • Essential H5591-020: $600 | Hancock, Piscataquis, Somerset, and Washington counties

Plan members must meet the 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. Learn More


Drug Copay Costs

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

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.


Martin's Point star iconEssential H5591-018 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost
Tier 4 | Non-Preferred Drug 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 5 | Specialty Tier 30% of cost NCB 30% of cost NCB 30% of cost NCB
Tier 6 | Select Care Drugs NCB NCB NCB NCB NCB NCB

 


Martin's Point star iconEssential H5591-019 | Aroostook, Franklin, Knox, Lincoln, Oxford, Penobscot, and Waldo counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost
Tier 4 | Non-Preferred Drug 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 5 | Specialty Tier 31% of cost NCB 31% of cost NCB 31% of cost NCB
Tier 6 | Select Care Drugs NCB NCB NCB NCB NCB NCB

 


Martin's Point star iconEssential H5591-020 | Hancock, Piscataquis, Somerset, and Washington counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost 22% of cost
Tier 4 | Non-Preferred Drug 32% of cost 32% of cost 32% of cost 32% of cost 32% of cost 32% of cost
Tier 5 | Specialty Tier 26% of cost NCB 26% of cost NCB 26% of cost NCB
Tier 6 | Select Care Drugs NCB NCB NCB NCB NCB NCB
2026 Plan Year 

Generations Advantage Prime, Select, and Essential

2026 Prime (HMO-POS) Plan

Prime Plan Drug Formulary
 Find out coverage and cost information for a specific medication or explore all covered drugs:

Prescription Deductible

Excludes Tier 1, Tier 2, and Tier 6 drugs

  • Prime H5591-006-001 & H5591-006-002: $300 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties
  • Prime H5591-016 & H5591-017: $275 | Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties

Plan members must meet the 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. Learn More


Drug Copay Costs

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

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.


Martin's Point star iconPrime H5591-006-001 & H5591-006-002 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $5 $15 $10 $30 $10 $25
Tier 3 | Preferred Brand 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 4 | Non-Preferred Drug 30% of cost 30% of cost 32% of cost 32% of cost 32% of cost 32% of cost
Tier 5 | Specialty Tier 29% of cost NCB 29% of cost NCB 29% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0

 


Martin's Point star iconPrime H5591-016 & H5591-017 | Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 4 | Non-Preferred Drug 30% of cost 30% of cost 32% of cost 32% of cost 32% of cost 32% of cost
Tier 5 | Specialty Tier 29% of cost NCB 29% of cost NCB 29% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0
2026 Select (LPPO) Plan

Select Plan Drug Formulary
 Find out coverage and cost information for a specific medication or explore all covered drugs:

Prescription Deductible

Excludes Tier 1, Tier 2, and Tier 6 drugs

  • Select H1365-001: $300 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties
  • Select H1365-005: $450 | Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties 

Plan members must meet the 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. Learn More


Drug Copay Costs

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

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.


Martin's Point star iconSelect H1365-001 | Androscoggin, Cumberland, Kennebec, Sagadahoc, and York counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $5 $15 $10 $30 $10 $25
Tier 3 | Preferred Brand 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 4 | Non-Preferred Drug 30% of cost 30% of cost 32% of cost 32% of cost 32% of cost 32% of cost
Tier 5 | Specialty Tier 29% of cost NCB 29% of cost NCB 29% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0

 


Martin's Point star iconSelect H1365-005 | Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties 

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $0 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 4 | Non-Preferred Drug 30% of cost 30% of cost 32% of cost 32% of cost 32% of cost 32% of cost
Tier 5 | Specialty Tier 27% of cost NCB 27% of cost NCB 27% of cost NCB
Tier 6 | Select Care Drugs $0 $0 $4 $12 $0 $0
2026 Essential (HMO-POS) Plan

Essential Plan Drug Formulary
 Find out coverage and cost information for a specific medication or explore all covered drugs:

Prescription Deductible: $300

Applies to all Essential plans
Excludes Tier 1, Tier 2, and Tier 6 drugs

Plan members must meet the 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. Learn More


Drug Copay Costs

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

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.


Martin's Point star iconAll Essential Plans | All Maine counties

NCB = Not Covered Benefit

Drug Tier Preferred Pharmacy
(Hannaford, CVS)		 Standard Pharmacy Mail-Order
30-day 90-day 30-day 90-day 30-day 90-day
Tier 1 | Preferred Generic $0 $0 $4 $12 $4 $0
Tier 2 | Generic $0 $0 $10 $30 $10 $25
Tier 3 | Preferred Brand 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost 25% of cost
Tier 4 | Non-Preferred Drug 30% of cost 30% of cost 32% of cost 32% of cost 32% of cost 32% of cost
Tier 5 | Specialty Tier 29% of cost NCB 29% of cost NCB 29% of cost NCB
Tier 6 | Select Care Drugs NCB NCB NCB NCB NCB NCB

*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).


Understanding Part D benefit video thumbnail

Using your Part D Prescription Drug benefit

Watch this video to learn more about this benefit and how to use it.

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 maximum copay

60-Day Supply—$70 maximum copay

90-Day Supply—$105 maximum copay

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 1-844-300-0160 (TTY: 711)
Current Members: Call Member Services at 1-866-544-7504 (TTY: 711)

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