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Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

Important Documents: Prescription Drug Coverage

Prescription Drug Coverage Summary

Prescription Drug Coverage
Annual Deductible
  • $0 for Tiers 1 and 2
  • $260 for Tiers 3, 4, and 5

Initial Coverage

Preferred Cost-Sharing Pharmacies
Amount for 30-day supply

Standard Cost-Sharing Pharmacies
Amount for 30-day supply

CVS Caremark Mail Service
Amount for 90-day supply

Tier 1: Preferred Generic

$0 copay

$6 copay

$0 copay

Tier 2: Generic

$5 copay

$10 copay

$10 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Drug

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

28% of the cost

28% of the cost

not available at 90-day supply
Coverage Gap

After your total yearly drug costs reach $4,660, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 25% of the plan's costs. For covered brand drugs, you pay no more than 25% of the plan's costs (excluding dispensing fees).
Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $7,400, you pay the greater of:

  • $4.15 copay for generics or brand drugs treated like generic drugs and a $10.35 copay for all other drugs; or
  • 5% of the cost

 

CVS Caremark, an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts.

Pharmacy Directory

There are over 1,000 pharmacies in our Massachusetts network and over 59,000 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

Find a Pharmacy Near You

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

Learn More

View Medicare Advantage Network and Formulary

  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Call 1-800-200-4255 (TTY: 711) for more information.
  • Every year, Medicare evaluates plans based on a 5-star rating system.