Prescription drug coverage is included on CHPW Medicare Advantage (MA) Plans 1, 2, 3, 4 and Dual Complete and Dual Select Plans (HMO D-SNP). Our coverage uses a tiered cost-sharing system. You pay either a fixed copay amount or a percentage of the total cost.

Prescription Cost-Sharing Tiers

Tier 1 represents the lowest cost generic drugs and Tier 5 represents the highest cost brand drugs and potent drugs that may require monitoring.

• Tier 1: Preferred Generic – includes lowest cost preferred generic drugs
• Tier 2: Generic – includes preferred generic drugs
• Tier 3: Preferred Brand – includes preferred brand drugs and non-preferred generic drugs
• Tier 4: Non-Preferred – includes non-preferred brand drugs and non-preferred generic drugs
• Tier 5: Specialty Tier – includes high cost and brand name drugs

Prescription Pricing

We can help you decide which tier of coverage you need based on the current medications you take. If you’re a current member, please call 1-800-942-0247 (TTY: 711). For prospective members, please call 1-800-944-1247 (TTY: 711). We’re here for you seven days a week, 8:00 a.m. to 8:00 p.m.

To discuss which prescription medications you need, contact your primary care provider or pharmacist.

And keep in mind—for the lowest copays, use a preferred pharmacy.

2025 Prescription Drug benefits

Medicare Advantage Dual Plans (Dual Complete and Dual Select)

Please see the prescription drug coverage page for more information about which specific medications are covered.

Preferred pharmacy options for Dual Complete (HMO D-SNP)

$0 (for generic drugs) $0 (all other drugs)

Preferred pharmacy options for Dual Select (HMO D-SNP)

$0 (for generic drugs) $0 (all other drugs)

Medicare Advantage Plans 2, 4 (HMO)

Preferred pharmacy

30-day supply cost 90-day supply cost Tier 1: $0 copay Tier 1: $0 copay Tier 2: $10 copay Tier 2: $20 copay Tier 3: $37 copay Tier 3: $110 copay Tier 4: 50% coinsurance Tier 4: 50% coinsurance Tier 5: 33% coinsurance Tier 5: Not covered

Standard pharmacy

30-day supply cost 90-day supply cost Tier 1: $10 copay Tier 1: $20 copay Tier 2: $20 copay Tier 2: $40 copay Tier 3: $47 copay Tier 3: $140 copay Tier 4: 50% coinsurance Tier 4: 50% coinsurance Tier 5: 33% coinsurance Tier 5: Not covered

Get the most of your prescription benefits

Additional highlights include:

• 90-day supply of select medications used to treat chronic conditions (e.g., high blood pressure, diabetes, depression)
• Free home delivery
• Searchable and printable prescription drug formularies (lists of covered drugs)
• Coverage accepted at more 1,000 Washington State pharmacies and more than 50,000 pharmacies nationwide

Eligibility criteria may apply. ➔ Learn more about Prescription Drug Coverage.

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December).

Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage* (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary.

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). There’s no cost to participate in the Medicare Prescription Payment Plan.

For more information, please see the Medicare Prescription Payment Plan Facts Sheet.

How to enroll

To enroll in the Medicare Prescription Payment Plan, or MPPP, you will need to fill out the enrollment form. You can do this online or by phone.

Online

Complete the online form at: https://www.express-scripts.com/mppp

Phone

Call Express Scripts at 1-866-845-1803 (TTY: 1-800-716-3231) 24 hours a day, 7 days a week to submit your request via telephone.

We’re here to help.

To ask questions, request print copies of materials, and more, contact Customer Service at 1-800-942-0247 (TTY: 711), 8:00 a.m. to 8:00 p.m., 7 days a week.