PLAN
INFORMATION
Saver Plan
Our lowest premiums, $0 deductible for many generic drugs, and $0 or low copays at preferred home delivery or retail pharmacies.
Plan Costs
Premium
A premium is a monthly payment for prescription drug coverage.
Annual Deductible
A deductible is the amount that you pay out-of-pocket for prescriptions before the plan begins to pay.
for generic drugs in Tiers 1 & 2 and select insulins in Tier 3
for all other drugs (Tiers 3,* 4 & 5)
*Excluding select insulins
Initial Coverage Stage
The Initial Coverage Stage begins after you have met your annual deductible (if your plan has one) and ends when your total drug costs reach the initial coverage limit. In this stage, you will pay the amounts listed based on the drug tier and the pharmacy you use.
What are drug tiers?
Each drug on a formulary (drug list) is placed on a tier, based on its cost.
| Pharmacy Type Days' Supply |
Preferred Home Delivery 90 Days |
Preferred Retail 30 Days |
Standard Retail 30 Days |
|---|---|---|---|
| Tier 1: Preferred Generic Drugs |
$0 | $2 | $19 |
| Tier 2: Generic Drugs |
$0 | $7 | $20 |
| Tier 3: Preferred Brand Drugs |
$105 | $35 | $47* |
| Tier 4: Non-preferred Drugs |
50% | 50% | 50% |
| Tier 5: Specialty Drugs |
28% For(30 days)supply |
28% | 28% |
| Preferred Home Delivery 90-day supply |
|
|---|---|
| Tier 1: Preferred Generic |
$0 |
| Tier 2: Generic |
$8 |
| Tier 3: Preferred Brand |
$90 |
| Tier 4: Non-preferred drugs |
From38% to - 50% For(30 days)supply |
| Tier 5: Specialty drugs |
25% For(30 days)supply |
| Preferred Retail 30-day supply |
|
|---|---|
| Tier 1: Preferred Generic |
$1 |
| Tier 2: Generic |
$4 |
| Tier 3: Preferred Brand |
$30 |
| Tier 4: Non-preferred drugs |
From36% to - 48% For(30 days)supply |
| Tier 5: Specialty drugs |
25% For(30 days)supply |
| Standard Retail 30-day supply |
|
|---|---|
| Tier 1: Preferred Generic |
$9 |
| Tier 2: Generic |
$12 |
| Tier 3: Preferred Brand |
$39 |
| Tier 4: Non-preferred drugs |
From38% to - 50% For(30 days)supply |
| Tier 5: Specialty drugs |
25% For(30 days)supply |
Coverage Gap Stage
You will enter the Coverage Gap Stage when your total drug costs exceed $4,130. In this stage, you will pay the amounts listed.
You pay $35 for Tier 3 select insulins at any network pharmacy in all stages through the Coverage Gap.
For other drugs, you pay:
of generic drug costs
of brand drug costs
Catastrophic Coverage Stage
You will enter the Catastrophic Coverage Stage when your yearly out-of-pocket costs exceed $6,550. In this stage, you will pay the amounts listed.
for generic drugs
for all other drugs (or 5% of the cost, whichever is greater)
Monthly premiums and copays/coinsurance may vary by region. For details, please see the Summary of Benefits or call an Express Scripts Medicare advisor. Remember, you must continue to pay your Medicare Part B premium.
*You pay $35 for Tier 3 select insulins at all network pharmacies in all stages up to the Catastrophic Coverage Stage.
Drug Coverage
The Saver plan Medicare Part D Formulary (drug list) has more than 2,900 drugs, including the most commonly used medications.
The Part D Senior Savings Model offers Tier 3 select insulin drugs at an affordable and predictable price to Saver plan members at any network pharmacy, in all stages up to the Catastrophic Coverage Stage. View a list of the included drugs.
If you receive "Extra Help," you do not qualify for this program, and your Low-Income Subsidy copay level will apply.
Pharmacy Network
Preferred retail pharmacies
In addition to a broad network of standard retail pharmacies, our Saver plan offers low copays at these preferred retail pharmacies:
The Kroger Family of Pharmacies includes Baker's, City Market, Dillons, Fred Meyer, Fry's, Gerbes, Harris Teeter, JayC, King Soopers, Mariano's, Metro Market, Owens, Payless, Pick 'n Save, QFC, Ralphs and Smith's.
Preferred home delivery from Express Scripts Pharmacy®
If you take prescription drugs on a regular basis, consider the added safety, convenient service and potential savings of having a 90-day supply delivered right to your mailbox.
- Low costs. Get up to a 90-day supply of your medication for a low copay or coinsurance.
- Added safety and convenience. We mail directly to your home so you can avoid making trips and waiting in line at the pharmacy. Medications typically arrive within 10 days after we receive the prescription from your doctor.
- Free standard shipping. Shipping is included as part of your plan at no additional cost.
- 24/7 care and service. Express Scripts pharmacists are available by phone to answer your medication questions, even in the middle of the night.
- Easy refills. Order refills quickly and easily on our website, with the Express Scripts® mobile app, by phone or by mail.
Do I have to use a “preferred retail” pharmacy?
Do I have to use a “preferred retail” pharmacy?
You may use any pharmacy in your plan’s network, but you typically pay less when you use a preferred retail pharmacy or preferred home delivery from Express Scripts Pharmacy®.
Please note: You may use our online searchable tool to confirm if your drugs are covered and which pharmacies are in-network. You may also compare all plans offered by Express Scripts Medicare if you are unsure which is best for you.
Need help?
Call 1.866.477.5703 TTY users: 1.800.716.3231
8 a.m. to 8 p.m., 7 days a week, except Thanksgiving and Christmas
Other pharmacies are available in our network.
If you qualify for Extra Help from Medicare to pay for your prescription drug costs, the amounts listed here may not apply to you.
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 includes limited lower-cost, preferred pharmacies in rural areas in Alaska; the Saver plan also includes limited lower-cost, preferred pharmacies in suburban areas in Puerto Rico, and the Choice plan also includes limited lower-cost, preferred pharmacies in rural areas in Oklahoma. 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 whether there are any lower-cost preferred pharmacies in your area, 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.
We have free interpreter services available to answer any questions you may have about the plan.
View information on multi-language interpreter services.