Prescription Drug Plan- ExpressScript Value

• $___ Monthly Premium
• $ 445 Deductible
  • Waived for Tier 1 and Tier 2 Prescriptions. Only applies to Tier 3-5 medications.

• Preferred Pharmacy Search
  • Express Scripts has preferred pharmacies where you may get lower co-pays.  Please use the above link to search for pharmacies near you.

• Summary of Benefits
• Formulary Rx List
• Carrier Star Ratings

Please see attached Medicare.gov RX Report.  This report shows the premiums, deductible, and copays for your prescriptions at your chosen retail pharmacy and the insurance carrier’s preferred mail order pharmacy.

Reading the Reports:

• All Medicare Prescription Drug Plans have 4 Stages of Coverage.  Please click on the link for more details.
• Please notice quantities of medications that are listed on the report and if they are listed as a 30 day or a 90 day supply.  
  • All drug costs quoted are for the quantity/frequency listed on the report. 
• Under your plan you are eligible to fill a 30 day or 90 day supply at your retail pharmacy or the carrier’s preferred mail order pharmacy. Please let us know if you would like your medications quoted at a different frequency amount.