Medicare Advantage Pharmacy Coverage
Everything You Need In One Place
Manage your prescription drug coverage
- Transfer or request a prescription, or order a refill
- Check the formulary for covered drugs
- Find in-network pharmacies near you
NEW! What You Pay for Part D Prescription Drugs
Beginning in 2025, there will be only three drug payment stages instead of four: the Yearly Deductible Stage, the Initial Coverage Stage, and the Catastrophic Coverage Stage. The Coverage Gap Stage and the Coverage Gap Discount Program will no longer exist in the Part D benefit.
How the Program Works
Yearly Deductible
Some plans may include a yearly deductible.
There is no deductible for your AZ Blue plan.
Initial Coverage
All plans: $2,000
The Initial Coverage is the member's out-of-pocket cost.
Once the member’s out-of-pocket costs reach $2,000, the member will then enter the Catastrophic Coverage Stage.
Catastrophic Coverage
Once the member’s out-of-pocket costs reach $2,000, the Catastrophic Coverage Stage begins.
The member will pay nothing for the remainder of the year for Part D covered drugs.
NEW! Medicare Prescription Payment Plan
Beginning in 2025, there is new payment plan option to help you manage your out-of-pocket Part D drug costs. It is available to anyone with a Medicare drug plan or Medicare health plan with drug coverage. Participation in the program is voluntary.
How the Program Works
There’s no cost to participate in the Medicare Prescription Payment Plan. If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy).
Pay Less and Get Your Prescriptions Delivered to Your Door
Save Costs with up to 100-day Supply & Mail Order
As a Medicare Advantage plan member, you can save by getting up to a 100-day supply of covered generic drugs through an in-network pharmacy or mail order. Save yourself a trip to the pharmacy by getting your prescriptions delivered right to your mailbox.
Save with your Over-the-Counter Allowance
Medicare Advantage members receive a quarterly allowance to buy health-related products from a catalog or from participating retail stores, such as Walgreens, CVS, Fry’s, Safeway and Albertsons.
Additional Pharmacy Resources
Medication Therapy Management
Use your medications safely and effectively with this no-cost service.Pharmacy Forms
Find pharmacy and prescription forms you may need, such as a drug claim form, mail-order form, or a prior authorization list, plus much more.Opioids Information & Dangers
Opioids can safely reduce pain when prescribed and used correctly. When misused, they can lead to addiction and even death. Knowing how to prevent opioid misuse and recognizing and responding to opioid overdose can help save a life.Diabetes Education
Be aware of your risks and improve your health through diabetes education.
Understanding the differences between medication types
- A brand-name drug is a first-to-market medication. Brand-name drugs may cost consumers more due to the time, money, and resources that drug companies invest in development and the clinical trials required by the Food and Drug Administration (FDA). Just because a drug carries a brand name, however, does not necessarily mean it’s more effective than a generic or similar brand-name medication.
- Generic drugs deliver the same amount of active ingredient in the same timeframe as their brand-name counterparts. Generics are required to have the same quality, strength, purity, and stability as brand-name product. Generally, using a generic drug can save you money by replacing a brand-name medication with the same active ingredient and dosage.
- Traditional drugs are used to treat general health and chronic conditions, such as flu, diabetes, or common infections. Specialty drugs are commonly used to address complex as well as rare diseases, such as rheumatoid arthritis and cancer. Both traditional and specialty drugs can be administered as an oral medication, infusion, or injectable.
What you need to know before filling your next prescription
- A drug list (sometimes called a formulary) describes which medications your health plan covers and how you share in the cost.
When you look at our plan's drug list, sometimes called the formulary, or use our online tools, you will notice that each covered drug is on a tier. Drug tiers are levels that we use to categorize prescription drugs and lower costs. Each tier costs a different amount. Typically, drugs on tier 1 will be the least expensive and drugs on tier 5 will be the most expensive.
Each drug on our drug list is put into 1 of 5 tiers. Each tier has a different cost-sharing amount in the form of a copay or coinsurance.
Tier 1: Preferred generic - Preferred generics. This is the lowest tier.
Tier 2: Generics.
Tier 3: Preferred Brand.
Tier 4: Non-Preferred Drugs.
Tier 5: Specialty Drugs (limited to a 30-day supply in-network Specialty or Retail pharmacies). This is the highest tier.
Tier 6: Select Care Drugs. This is a $0 tier.