Notes

• A one-month (34-day supply or less) prescription is not covered at mail-order.
• The Maximum Fair Price for the CMS selected drugs does not include the additional dispensing fee in the Medicare prescription drug costs throughout the site. The full cost will not exceed the maximum fair price plus dispensing fees for drugs with negotiated prices under the Medicare Drug Price Negotiation Program. The dispensing fees are $1.00 for non-Rural Retail pharmacy, $2.50 for a Rural Retail pharmacy, $0.00 for Mail Order or $15.00 for a Long-Term Care (LTC) pharmacy.

Plan Overview

Plan identifiers

Carrier contact