Estimated pricing and coverage for medication is based on a sample plan design and may change based upon your benefit selection. Medication prices, individual retail pricing and individual copayments may vary.
Pharmacist's judgment, your doctor's instructions on how to take the medication, and applicable law may impact the actual dispensed quantity and/or days' supply you may receive. Medication costs outside of your prescription program, and sales tax, where applicable, are not included.
Savings amounts may vary based on drug prices, prescription programs, including deductibles and out-of-pocket expenses, in effect at the time of the savings calculation, applicable law and pharmacist's judgment.
Medication costs outside of your prescription program, and sales tax, where applicable, are not included. In most cases, if alternative drugs are listed, they are preferred by your prescription program. Some or all of the alternative drugs may not be appropriate for you and all will require your doctor's approval.
The coverage and pricing terms of the prescription benefit are subject to change. This information is a general overview of your prescription benefit program. Certain prescription drugs may be subject to prior authorization (you will need to get approval from your plan before you fill certain prescriptions), step therapy (you may need to try a different, less expensive or more common drug first), quantity limitations, and age or gender restrictions. Please note that the pricing and coverage terms of prescription benefits are subject to change. Individual retail pricing may vary.
To ask for drug exception coverage, go to the Part D Coverage Determination section. To file a redetermination for drug coverage, please see the Appeals section.
