PRESCRIPTION DRUG COVERAGE

Your Medicare prescription coverage

When you log in to your account, you can check your pharmacy benefits, see medication lists and chat with us about your options.

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See if we cover your drugs

Our covered drug lists (also called formularies) tell you what Part D prescription drugs we cover. They also tell you what tier each drug is in. This helps you know how much you can expect to pay at the pharmacy. You can find our 2026 covered drug lists below.

See our 2026 covered drug list for members of:

BlueAdvantage Sapphire (PPO)℠
BlueAdvantage Garnet (PPO)℠
BlueAdvantage Ruby (PPO)℠
BlueAdvantage Diamond (PPO)℠
BlueAdvantage Total Heart and Diabetes (PPO C-SNP)℠

View Drug List (Formulary) (Updated: 7/1/2026)

See our 2026 covered drug list for members of:

BlueAdvantage Extra (PPO)℠
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP)℠

View Drug List (Formulary) (Updated: 7/1/2026)

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See pharmacies in your area

We can help you find a pharmacy that’s near you and in your network.

Find a pharmacy

Save money and time with home delivery

If you take a prescription regularly, you can save on the cost of your medication when you get three-month supplies sent to your home with home delivery from CVS/Caremark. Sign up for delivery, and we’ll help you make the most of your prescription benefits without even leaving home.

UNDERSTANDING MEDICARE PHARMACY COVERAGE

Let’s help you find answers to pharmacy questions

See all questions

How do I find a pharmacy in my network?
What are “preferred” drugs or pharmacies?
Preferred drugs and pharmacies can help you save money. Our doctors and pharmacists create a list of preferred drugs for our list of covered drugs (called a formulary). For the most part, this list is divided into tiers. Lower tiers are usually made up of preferred drugs, which have lower cost shares. You usually save money when you use lower-tier drugs.
Our drug tiers are:
Tier 1 - Preferred Generic Drugs (lowest cost-share)
Tier 2 - Generic Drugs
Tier 3 - Insulin Drugs
Tier 3 - Preferred Brand Drugs
Tier 4 - Non-Preferred Drugs
Tier 5 - Specialty Drugs (highest cost-share)
Some plans include a list of preferred pharmacies that have agreed to keep costs lower for our members. You’ll save money if you use them.

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What is a specialty pharmacy or drug?

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A little Extra Help can go a long way

Prescription coverage is important, but it can also be a big expense. Members who qualify can lower their prescription costs with the Extra Help program through Social Security.

See if you’re eligible and how to apply

What qualifies you for Extra Help?
You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance)
You live in the United States
You meet the income and resource limit
What are the income and resource limits?
Your income is how much money you make each year.
Your resources are things of value that you own, like real estate, bank accounts and investments. Go to Medicare.gov for details on what counts in resources limits.

The income limit is based on your income from the previous year.
Your Status Income Limit Resource Limit
Single $23,475 $17,600
Married couple living together $31,725 $35,130
What are the benefits?
Premium assistance
No deductible
Up to $4.90 for each generic drug
Up to $12.15 for each brand name drug
How do I apply for Extra Help?
There are three ways to apply.
Apply online at Social Security.
Apply over the phone by calling Social Security at 1-800-772-1213, TTY 1-800-325-0778. Available in most U.S. time zones Monday – Friday 8 a.m. – 7 p.m. in English and other languages.
Apply in person at your local Social Security Office.
After you apply, Social Security will review your application and send you a letter to let you know if you qualify for Extra Help. And, if you do, you can choose a Medicare Advantage Prescription Drug Plan. If you don’t select a plan, the Centers for Medicare & Medicaid Services (CMS) will do it for you. The sooner you join a plan, the sooner you begin receiving benefits.
If you qualify for Extra Help but your plan hasn’t been notified by CMS, you can show certain documents to your pharmacy and pay a lower copay.

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Medicare Prescription Payment Plan

You can pay for your prescriptions over time with monthly payments. Click here to learn more. If you’re having trouble paying for your prescriptions and you qualify, Social Security’s Extra Help program can help lower your prescription payments. If you need help, give us a call at 1-800-831-2583, TTY 711 Monday through Friday from 8 a.m. to 9 p.m. ET.

How do I opt-in or opt-out of the Medicare Prescription Payment Plan program?
You can sign up through your online account or by printing and filling out this PDF. Please see Terms and Conditions for additional information.
If you had an urgent prescription filled that you paid for before we received and processed your enrollment in the Medicare Prescription Payment Plan, you’ll be able to get a retroactive election into the program. You can get a retroactive election if:
You think any delay in getting your prescription would harm your life, health or ability to function.
You ask for the retroactive enrollment within 72 hours of filling your urgent prescription.
Once you’re enrolled in the plan, we’ll reimburse you for any cost-share you paid for your urgent prescription and any other covered Part D prescription filled between the urgent claim and the date your payment plan started. We’ll reimburse you within 45 days of your enrollment date.
If we determine you didn’t ask for retroactive election within the required timeframe, we’ll let you know and give you instructions on how to file a grievance.
How do I submit a complaint?

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MORE ABOUT MEDICATION THERAPY MANAGEMENT

Medication Therapy Management (MTM)

Medication Therapy Management (MTM) is a free program we offer eligible Medicare Advantage Prescription Drug plan members. It’s intended to help improve medication use, lower the risk of medication interactions and help members take medications as prescribed. The program includes a one-on-one phone or in-person consultation with a pharmacist or other qualified provider to review your prescription and over-the-counter medications. This is called a comprehensive medication review (CMR). It’s designed just for you and usually takes around 15-20 minutes.

What's covered during a comprehensive medication review?
During your personalized review, the pharmacist or other qualified provider will talk with you about:
Whether your medications are working like they should
Whether you’re having any side effects from your medications
Whether there are lower cost medications on your plan’s covered drug list that you could discuss with your prescriber to see if they might be right for you
Locations where you can safely throw away unused medications
At the end of the review, you’ll get a copy of your list of medications and a letter with the topics you discussed. You can share that information with your doctor. You’ll also get instructions for how to safely dispose of old medications.
Who’s eligible for this program?
To be eligible you must:
Have three or more of these ongoing or chronic health issues:
Alzheimer’s Disease
Bone Disease - Arthritis (Osteoporosis, Osteoarthritis, and Rheumatoid Arthritis)
Chronic Heart Failure
Diabetes
Dyslipidemia
End-stage Renal Disease
HIV/AIDS
Hypertension
Mental Health - Depression, Schizophrenia, Bipolar Disorder, and other Chronic and Disabling Mental Health Conditions)
Respiratory Disease (Asthma, Chronic Obstructive Pulmonary Disease (COPD), and other Chronic Lung Disorders)
Have spent $318.99 on medications in three months
Take eight (8) or more medications
Members in the Drug Management Program will be automatically enrolled.
What do I need to do to enroll?
You don’t have to do anything. You’ll be automatically enrolled if you’re eligible. We’ll send you a letter to notify you. Once you’re enrolled, you’ll get the yearly comprehensive medication review, which includes an updated medication list and safe drug disposal tips. You’ll also get quarterly targeted medication reviews (TMRs) that look for changes in the drugs you take that might need to be addressed with your prescriber. We’ll send your prescriber a fax with suggested changes if necessary. Your MTM pharmacist or other qualified provider will also follow up with you, if needed.
You don’t have to participate in the MTM program if you don’t want to, and the MTM program doesn’t impact your plan Part D benefits, copays, coverage, or providers and pharmacies that may be in your plan’s network. You can decline certain parts of the MTM program and still stay enrolled, too.
Here are some of the resources to help you prepare for your comprehensive medication review:
Blank medication List
Drug Disposal Information
Questions? Give us a call at 1-800-831-2583 (TTY 711).

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MORE ABOUT MEDICATION THERAPY MANAGEMENT

Medication Therapy Management (MTM)

Your Status	Income Limit	Resource Limit
Single	$23,475	$17,600
Married couple living together	$31,725	$35,130

PRESCRIPTION DRUG COVERAGE

See our 2026 covered drug list for members of:

See our 2026 covered drug list for members of:

UNDERSTANDING MEDICARE PHARMACY COVERAGE

How do I find a pharmacy in my network?

What are “preferred” drugs or pharmacies?

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What is a specialty pharmacy or drug?

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What qualifies you for Extra Help?

What are the income and resource limits?

What are the benefits?

How do I apply for Extra Help?

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How do I opt-in or opt-out of the Medicare Prescription Payment Plan program?

How do I submit a complaint?

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MORE ABOUT MEDICATION THERAPY MANAGEMENT

What's covered during a comprehensive medication review?

Who’s eligible for this program?

What do I need to do to enroll?

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What are “preferred” drugs or pharmacies?

What is a specialty pharmacy or drug?

What qualifies you for Extra Help?

What are the income and resource limits?

What are the benefits?

How do I apply for Extra Help?

How do I opt-in or opt-out of the Medicare Prescription Payment Plan program?

How do I submit a complaint?

MORE ABOUT MEDICATION THERAPY MANAGEMENT

What's covered during a comprehensive medication review?

Who’s eligible for this program?

What do I need to do to enroll?

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