*Premiums may vary by region. Remember, you must continue to pay your Medicare Part B premium.
†Other pharmacies are available in our network. Preferred pharmacies agree to charge less for certain prescription drugs. You may use any network pharmacy in your plan, but you will typically pay less when you use a preferred retail pharmacy or home delivery from the Express Scripts Pharmacy.
Medicare Part B prescription drugs are not covered under the prescription drug benefit (Part D). Generally, we cover only prescription drugs, vaccines, biological products and medical supplies that are covered under the Medicare prescription drug benefit (Part D) and that are on our formulary.
Express Scripts Medicare's pharmacy network offers limited access to pharmacies with preferred cost-sharing in rural areas in Alaska; the Saver plan also offers limited access to pharmacies with preferred cost-sharing in rural and suburban areas in Arkansas, Iowa, Minnesota, Montana, Nebraska, North Dakota, Puerto Rico, South Dakota, Wisconsin and Wyoming; and in rural areas only in Idaho, Kansas, Maine, Michigan, Mississippi, Missouri, New Hampshire, New Mexico, Oklahoma, Oregon, Utah and Washington; the Choice and Value plans also offer limited access to pharmacies with preferred cost-sharing in suburban areas in Hawaii. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost-sharing, please call Customer Service at 1.866.477.5703; TTY: 1.800.716.3231, or consult the online Pharmacy Directory.
Certain prescription drugs will have maximum quantity limits.
Your prescriber must get prior authorization from Express Scripts Medicare for certain prescription drugs.
Covered Part D drugs are available at out-of-network pharmacies under certain circumstances, including illness while traveling outside the plan's service area, where there is no network pharmacy. You may also incur an additional cost for drugs received at an out-of-network pharmacy.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.
We have free interpreter services to answer any questions you may have about the plan.
View information on multi-language interpreter services.
Express Scripts Medicare (PDP) is a prescription drug plan with a Medicare contract.
Enrollment in Express Scripts Medicare depends on contract renewal.