Part D Prescription Drug Coverage
MVP’s Medicare Advantage plans offer the convenience of both medical coverage and Part D prescription drug coverage together in one plan, and with one convenient monthly bill. Plus, with MVP’s mail order program, you can often get a three-month supply for the price of two!
MVP’s 2019 coverage for medically necessary Medicare Part D approved drugs includes:
- Tier 1 – Preferred Generic Drugs
- Tier 2 – Generic Drugs
- Tier 3 – Preferred Brand Name Drugs
- Tier 4 – Non-Preferred Drugs
- Tier 5 – Specialty Drugs
Depending on which MVP Medicare Advantage plan you choose, Tier 1 drugs are available at $0 or no more than $4 during the Deductible and Initial Coverage Stages.
Part D drugs excluded from MVP’s Part D Formulary must go through an exception process in order for MVP to cover them. If they are approved, they will be covered in Tier 4.
Compare estimates of your prescription drug and out-of-pocket costs per plan
MVP 2019 Medicare Part D Coverage Details
Initial Coverage Period
View your cost for a 30-day supply from a retail pharmacy in Medicare Part D’s Initial Coverage Period. Costs vary by MVP Medicare plan and region.
Coverage in the Gap
If your total drug costs in 2019 reach $3,820, you enter the Coverage Gap:
With WellSelect and GoldSecure plans, you pay 27% for generic drugs and 25% for Medicare-contracted brands in the Gap.
With GoldValue, Gold PPO, and Preferred Gold plans, you pay $0 for Tier 1 drugs, and 37% for generic drugs and 25% for Medicare-contracted brands in Tiers 2-5.
Reaching the $5,100 Catastrophic Coverage Limit in 2019:
If your True Out-of-Pocket costs reach $5,100 in 2019, you reach the Catastrophic Coverage Limit and your cost for prescriptions is reduced to the greater of 5% or $3.40 for generics and $8.50 for brand-name drugs.
Note: If you do not join a Medicare Part D plan when you first become eligible for Medicare, or do not have coverage as good as Medicare’s, you may have to pay a penalty if you join at a later date. This penalty will apply for as long as you are enrolled in Part D coverage. Learn more.
Programs that may help you save money
- Check anytime to see if you are eligible for help from a State Pharmacy Assistance Program.
- In New York State, call EPIC (Elderly Pharmaceutical Insurance Coverage) program at 1-800-332-3742.
- In Vermont, call the Vermont Prescription Assistance program at 1-800-250-8427.
- Check anytime to see if you are eligible to receive Extra Help with prescriptions (called Low Income Subsidy).
- Call the Social Security Administration Office at 1-800-772-1213. TTY: 1-800-325-0778.
- In New York you can also call the New York State Health Insurance Information, Counseling and Assistance Program at 1-800-333-4114.
- In Vermont, call the Area Agency on Aging of Vermont at 1-800-552-3402.
NOTE: If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay part of your monthly plan premium. MVP will bill you for the amount that Medicare does not cover.
Medicare Advantage Part D Covered Drugs and Pharmacy Directory
For certain prescription drugs, MVP has additional requirements or limits on our coverage to ensure that our members use these drugs effectively and to help control drug plan costs. Learn more about our Covered Drugs.
You can ask MVP to cover a drug for a lower cost, remove a coverage requirement or limitation, or cover a drug that is not listed on the Formulary. This is called a coverage determination. Learn more about MVP’s coverage determinations.
Click here to view MVP’s 2019 Medicare Advantage Pharmacy Directory or find a pharmacy near you.
Ver el directorio de farmacias 2019 Medicare Advantage de MVP.
Want more information?
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Call our expert Medicare team:
1-800-324-3899 TTY: 1-800-662-1220
Monday – Friday, 8 am – 8 pm Eastern Time.
Or call the MVP Medicare Customer Care Center
Monday – Friday, 8 am – 8 pm 1-800-665-7924 (TTY: 1-800-662-1220).
From October 1 – March 31, call us every day from 8 am – 8 pm.