2020

PLAN
INFORMATION

Choice Plan

A great option if you want even more drug coverage, our lowest deductible, and $0 generics (Tier 1) delivered right to you.

Plan Costs

Premium

A premium is a monthly payment for prescription drug coverage.

Annual Deductible

A deductible is the amount that you must pay out-of-pocket for prescriptions before the plan begins to pay.

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?

What are drug tiers?
Each drug on a formulary (drug list) is placed on a tier, based on its cost. The lower the tier, the less you pay for the drug.

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 $4,020. In this stage, you will pay the coinsurance amounts listed.

Catastrophic Coverage Stage

You will enter the Catastrophic Coverage Stage when your yearly out-of-pocket costs exceed $6,350. In this stage, you will pay the amounts listed.

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.

Drug Coverage

The Choice plan Medicare Part D Formulary (drug list) has 3,200 drugs, including the most commonly used medications.

Pharmacy Network

In addition to a broad network of standard retail pharmacies and the Express Scripts home delivery pharmacy, our Choice plan offers savings and convenience when using one of the following preferred retail pharmacies:

Walgreens Pharmacy
Kroger

The Kroger Family of Pharmacies includes Dillons, Harris Teeter, Smith's, Ralphs, Pick 'n Save, Metro Market, Mariano's, King Soopers, Fred Meyer, Fry's, City Market, Baker's, Gerbes, Payless, JayC, Owens and QFC.*

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 home delivery.

Please note: 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 rural areas in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming; and in suburban areas in Puerto Rico. 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.