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Check your pharmacy benefits | Mass General Brigham Health Plan
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Advantage prescription drug coverage includes hundreds of<br /> generic and brand-name medications, all with no deductible. </p> <p> </p> </div> </div> </div> </div> </div> </div> </div> </div> <div class="containerlayout aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --site-max-width --grid-normal-one-column --bg-color-neutral-white"> <div class="cmp-containerlayout__content-column "> <div class="contentlayout --margin-large-left --margin-large-right"><div class="cmp-contentlayout"> <div class="cmp-contentlayout__content --content-col-content --"> <div class="spacer"><div class="cmp-custom-spacer --small "> </div> </div> <div class="text component-heading-typography primary-blue-color"> <div id="text-bffbdf2165" class="cmp-text"> <h2 style=" text-align: left; ">Check your prescription drug coverage</h2> </div> </div> <div class="text component-body-typography"> <div id="text-ff6bff87f2" class="cmp-text"> <p>See if your current medications are covered by searching our online formulary.</p> </div> </div> <div class="button cmp-button--tertiary-btn"><a id="button-69d5e3ae3b" class="cmp-button" href="https://www.medicareplanrx.com/jccf/MassGeneralBrighamHealthPlan_formulary_25.html" target="_blank"> <span class="cmp-button__text"> <span class="--button-text-content">Search for your prescriptions - 2025</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> </div> <div class="button cmp-button--tertiary-btn"><a id="button-4cff8b34b1" class="cmp-button" href="https://www.medicareplanrx.com/jccf/allways_formulary_24.html" target="_blank"> <span class="cmp-button__text"> <span class="--button-text-content">Search for your prescriptions - 2024</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> </div> <div class="text component-body-typography"> <div id="text-34d4ab65a3" class="cmp-text"> <p><br /> Medications in the formulary are categorized into different tiers. When you know what tier your medication is in, you can find out what your cost sharing will be.</p> </div> </div> <div class="text component-heading-typography"> <div id="text-e6a0af3b7a" class="cmp-text"> <p><br /> 2025 pharmacy information<br /> </p> </div> </div> <div class="button cmp-button--tertiary-btn"><a id="btnRxSearch2025" class="cmp-button" href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2025_Medicare_Advantage_Formulary_HMO_PPO.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">View the 2025 Medicare Part D formulary (list of covered drugs)</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>11/26/2024</span> </div></div> <div class="button cmp-button--tertiary-btn"><a id="button-6cc12623fc" class="cmp-button" href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2025_Rx%20Prior%20Auth%20Medical%20Necessity%20Guidelines.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">2025 Prior Authorization Medical Necessity Guidelines</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>11/15/2024</span> </div></div> <div class="button cmp-button--tertiary-btn"><a id="button-1c22906890" class="cmp-button" href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2025_Rx%20Step%20Therapy%20Medical%20Necessity%20Guidelines.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">2025 Step Therapy Medical Necessity Guidelines</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>10/15/2024</span> </div></div> <div class="text component-heading-typography"> <div id="text-8d770e8e9b" class="cmp-text"> <p><br /> 2024 pharmacy information</p> </div> </div> <div class="button cmp-button--tertiary-btn"><a id="btnRxSearch2024" class="cmp-button" href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2024_Medicare_Advantage_Formulary.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">View the 2024 Medicare Part D formulary (list of covered drugs)</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>Updated 11/1/2024</span> </div></div> <div class="button cmp-button--tertiary-btn"><a id="button-3d2d5ef074" class="cmp-button" href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2024_Rx%20Prior%20Auth%20Medical%20Necessity%20Guidelines.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">2024 Prior Authorization Medical Necessity Guidelines</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>Updated 11/1/2024</span> </div></div> <div class="button cmp-button--tertiary-btn"><a id="button-002729b0e0" class="cmp-button" href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2024_Rx%20Step%20Therapy%20Medical%20Necessity%20Guidelines.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">2024 Step Therapy Medical Necessity Guidelines</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>Updated 11/1/2024</span> </div></div> <div class="containerlayout --margin-small-top"><div class="cmp-containerlayout --grid-normal-one-column --site-max-width --bg-color-neutral-near-white"> <div class="cmp-containerlayout__content-column "> <div class="text component-body-typography neutral-medium-gray-color"> <div id="text-d19601e37e" class="cmp-text"> <p><br /> If you need more pharmacy information, you can find drug coverage and pharmacy forms on our <a href="/member-resources/forms-resources">Forms & Resources page</a>.</p> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="containerlayout aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --site-max-width --grid-normal-one-column --bg-color-neutral-white"> <div class="cmp-containerlayout__content-column "> </div> </div> </div> <div class="containerlayout --margin-small-top --margin-small-bottom aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --grid-two-column-six-six --site-max-width --bg-color-neutral-white"> <div class="cmp-containerlayout__content-column"> <div class="image"> <div data-cmp-is="image" data-cmp-src="/us/en/home/plans/rx-information/_jcr_content/root/container/containerlayout_1346_978087172/column1/image.coreimg{.width}.jpeg/1727994305089/image-doctor-holding-tablet-cropped-01.jpeg" data-asset-id="c45c51ee-9760-4e65-aca5-d32c9acf997c" data-cmp-filereference="/content/dam/mgbhp/aep-25-launch/image-doctor_holding_tablet_cropped-01.jpg" id="image-2720d8241b" data-cmp-hook-image="imageV3" class="cmp-image" itemscope itemtype="http://schema.org/ImageObject"> <img src="/plans/rx-information/_jcr_content/root/container/containerlayout_1346_978087172/column1/image.coreimg.jpeg/1727994305089/image-doctor-holding-tablet-cropped-01.jpeg" loading="lazy" class="cmp-image__image" itemprop="contentUrl" width="600" height="600" alt="Doctor holding a tablet. "/> </div> </div> </div> <div class="cmp-containerlayout__content-column"> <div class="contentlayout --margin-small-left"><div class="cmp-contentlayout"> <div class="cmp-contentlayout__content --content-col-content --"> </div> </div> </div> <div class="contentlayout --margin-small-left --margin-small-top"><div class="cmp-contentlayout"> <div class="cmp-contentlayout__content --content-col-content --"> <div class="text component-heading-typography primary-blue-color"> <div id="text-aa9e937eb2" class="cmp-text"> <h2 style=" text-align: left; ">For Employer Group Waiver Plans (EGWPs) </h2> </div> </div> <div class="button cmp-button--tertiary-btn"><a id="button-66be9d994f" class="cmp-button" href="https://secure-web.cisco.com/1xU0Y46Aql1S5AARg0evRAaSlBawRnDJIN1pXaAJDf2sobeX-B4ZRZoPmMYnTvT_neQr9YK9NXbH1BL5F9MlJbGlxwcZf-qPJuSN3vB3cMIvAI_hBXZx6iWQRFLD3C02xQ-ECTayeFRlGZi2Q73jPhXnwDRUBMcvE1lI1g6mxnFptBG_iXpUG7ueFm8jZuk1ja1iCc2dftjZqdKszDWM7vFL5ZmRwBHMR1FMMRuhqWs0PlBOt4VvtODe1vqjGPVHybSjOqUp7Lm-YVOl_TQnILccWjEJaCGSrE1UKiYlTyHUPJFJQHIqgYvuIbKG3cqCd/https%3A%2F%2Fwww.medicareplanrx.com%2Fjccf%2FMassGeneralBrighamHealthPlan_three_tier_formulary_25.html" target="_blank"> <span class="cmp-button__text"> <span class="--button-text-content">Search for your prescriptions online</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> </div> <div class="button cmp-button--tertiary-btn"><a id="button-ad994366fd" class="cmp-button" href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2025_Medicare_Advantage_Formulary_EmployerGroup.pdf" target="_blank"> <span class="cmp-button__text"> <span class="--button-text-content">2025 Medicare Part D formulary</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext "> <span>Updated 11/26/2024</span> </div></div> </div> </div> </div> </div> </div> </div> <div class="containerlayout --margin-medium-top --margin-medium-bottom aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --grid-normal-one-column --full-width --bg-color-light-teal"> <div class="cmp-containerlayout__content-column "> <div class="containerlayout --margin-medium-top --margin-medium-bottom"><div class="cmp-containerlayout --grid-normal-one-column --site-max-width --bg-color-light-teal"> <div class="cmp-containerlayout__content-column "> <div class="text component-heading-typography primary-blue-color"> <div id="text-712ce3bb09" class="cmp-text"> <h2 style=" text-align: left; ">Did you know? Members get $0 preferred<br /> generic drugs at pharmacies nationwide</h2> </div> </div> <div class="text component-body-typography"> <div id="text-5f751c3c68" class="cmp-text"> <p>Commonly used generic medications in Tier 1 of our Formulary are covered at no additional cost to <br /> members. Talk to your doctor to see if these medications may be right for you.</p> </div> </div> </div> </div> </div> </div> </div> </div> <div class="containerlayout --margin-small-top --margin-small-bottom aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --grid-two-column-six-six --site-max-width --bg-color-neutral-white"> <div class="cmp-containerlayout__content-column"> <div class="contentlayout"><div class="cmp-contentlayout"> <div class="cmp-contentlayout__content --content-col-content --"> <div class="text component-heading-typography primary-blue-color"> <div id="text-c87ac8014f" class="cmp-text"> <h2 style=" text-align: left; ">Convenient<br /> pharmacy access</h2> </div> </div> <div class="text component-body-typography"> <div id="text-80044f0539" class="cmp-text"> <p>Members have access to thousands of participating pharmacies, including all major pharmacy chains.<br /> </p> </div> </div> <div class="button cmp-button--primary-btn cmp-button--standard-btn-height"><a id="btnFindPharmacy2025" class="cmp-button" href="https://www.medicareplanrx.com/jccf/MassGeneralBrighamHealthPlan_pharmacy_25.html" target="_blank"> <span class="cmp-button__text"> <span class="--button-text-content">Find a pharmacy near you - 2025</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> </div> <div class="button cmp-button--tertiary-btn"><a id="btnFindPharmacy2024" class="cmp-button" href="https://sit3xws85.caremark.com/jccf/allways_pharmacy_24.html" target="_blank"> <span class="cmp-button__text"> <span class="--button-text-content">Find a pharmacy near you - 2024</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> </div> <div class="button cmp-button--tertiary-btn"><a id="button-0a73335b2e" class="cmp-button" href="http://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2025_PharmacyDirectory.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">View the 2025 Medicare Advantage Pharmacy Directory</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>Updated 11/1/2024</span> </div></div> <div class="button cmp-button--tertiary-btn"><a id="button-41a8077386" class="cmp-button" href="http://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2024_PharmacyDirectory.pdf" target="_blank"> <span class="cmp-button__left-icon --regular-icon-file-download" aria-hidden="true"></span> <span class="cmp-button__text"> <span class="--button-text-content">View the 2024 Medicare Advantage Pharmacy Directory</span> </span> <span class="cmp-button__icon"> <svg width="10" height="16" viewBox="0 0 10 16" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M6.26175 8L0.128418 1.86667L1.53342 0.46167L9.07175 8L1.53342 15.5383L0.128418 14.1333L6.26175 8Z"/> </svg> </span> </a> <div class="cmp-button__subtext --has-additional-padding"> <span>Updated 11/1/2024</span> </div></div> </div> </div> </div> </div> <div class="cmp-containerlayout__content-column"> <div class="image"> <div data-cmp-is="image" data-cmp-src="/us/en/home/plans/rx-information/_jcr_content/root/container/containerlayout_1346/column2/image.coreimg{.width}.jpeg/1727994334277/image-pharmacist-01.jpeg" data-asset-id="5431a5e7-0069-40ed-8983-d63fa7b0a752" data-cmp-filereference="/content/dam/mgbhp/aep-25-launch/image-pharmacist-01.jpg" id="image-522618c692" data-cmp-hook-image="imageV3" class="cmp-image" itemscope itemtype="http://schema.org/ImageObject"> <img src="/plans/rx-information/_jcr_content/root/container/containerlayout_1346/column2/image.coreimg.jpeg/1727994334277/image-pharmacist-01.jpeg" loading="lazy" class="cmp-image__image" itemprop="contentUrl" width="600" height="600" alt="Pharmacist checking her tablet inside a pharmacy."/> </div> </div> </div> </div> </div> <div class="containerlayout --margin-small-top --margin-medium-bottom aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --grid-two-column-six-six --site-max-width --bg-color-neutral-white"> <div class="cmp-containerlayout__content-column"> <div class="image"> <div data-cmp-is="image" data-cmp-src="/us/en/home/plans/rx-information/_jcr_content/root/container/containerlayout_1346_1237826626/column1/image.coreimg{.width}.jpeg/1727994391866/image-couple-playing-soccer-01.jpeg" data-asset-id="178335ac-e9fe-4890-af4f-3c3f5ccd3164" data-cmp-filereference="/content/dam/mgbhp/aep-25-launch/image-couple_playing_soccer-01.jpg" id="image-4dd8bd6f10" data-cmp-hook-image="imageV3" class="cmp-image" itemscope itemtype="http://schema.org/ImageObject"> <img src="/plans/rx-information/_jcr_content/root/container/containerlayout_1346_1237826626/column1/image.coreimg.jpeg/1727994391866/image-couple-playing-soccer-01.jpeg" loading="lazy" class="cmp-image__image" itemprop="contentUrl" width="600" height="600" alt="Elderly couple playing soccer in a park. "/> </div> </div> </div> <div class="cmp-containerlayout__content-column"> <div class="contentlayout --margin-small-left"><div class="cmp-contentlayout"> <div class="cmp-contentlayout__content --content-col-content --"> <div class="text component-heading-typography primary-blue-color"> <div id="text-f20d066c90" class="cmp-text"> <h2 style=" text-align: left; ">Medicare Part D Coverage Details - 2025</h2> </div> </div> <div class="text component-body-typography"> <div id="text-22958e488e" class="cmp-text"> <p><b>Initial coverage period </b></p> <p>When your coverage begins, you pay your cost share for covered prescription drugs. View costs for a 30-day supply from a participating retail pharmacy in the table below.</p> <p><b>Reaching the Catastrophic Coverage Limit</b><br /> </p> <p>Beginning in 2025, if your out-of-pocket costs for Part D drugs reaches $2,000, you reach the Catastrophic Coverage Stage and pay nothing for covered Part D drugs. You may have cost sharing for drugs that are covered under our enhanced benefit.<br /> </p> </div> </div> </div> </div> </div> </div> </div> </div> <div class="containerlayout aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --site-max-width --grid-normal-one-column --bg-color-neutral-white"> <div class="cmp-containerlayout__content-column "> <div class="text component-heading-typography"> <div id="text-9f3287d4f1" class="cmp-text"> <h2>Rx information for members</h2> </div> </div> <div class="accordion panelcontainer"> <div id="accordion-246372a35a" class="cmp-accordion" data-cmp-is="accordion" data-placeholder-text="false"> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-246372a35a-item-af64ee07f9":{"@type":"mgbhp/components/accordion/item","dc:title":"Don’t see your prescription in our formulary?"}}" id="accordion-246372a35a-item-af64ee07f9"> <h3 class="cmp-accordion__header"> <button id="accordion-246372a35a-item-af64ee07f9-button" class="cmp-accordion__button" type="button" aria-controls="accordion-246372a35a-item-af64ee07f9-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Don’t see your prescription in our formulary?</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-246372a35a-item-af64ee07f9-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-246372a35a-item-af64ee07f9-button"><div class="container responsivegrid"> <div id="container-af64ee07f9" class="cmp-container"> <div class="aem-Grid aem-Grid--10 aem-Grid--default--10 "> <div class="text component-body-typography aem-GridColumn aem-GridColumn--default--10"> <div id="text-60f1fd0ff4" class="cmp-text"> <p>If you’re taking a medication that isn’t covered under our formulary, we can work with you to refill your prescription during your transition.<br /> </p> <p>Transitional supplies are available to some members within 90 days of their enrollment effective date. See our frequently asked questions for more details.</p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-246372a35a-item-d64802dfb3":{"@type":"mgbhp/components/accordion/item","dc:title":"Assistance programs for medication costs"}}" id="accordion-246372a35a-item-d64802dfb3"> <h3 class="cmp-accordion__header"> <button id="accordion-246372a35a-item-d64802dfb3-button" class="cmp-accordion__button" type="button" aria-controls="accordion-246372a35a-item-d64802dfb3-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Assistance programs for medication costs</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-246372a35a-item-d64802dfb3-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-246372a35a-item-d64802dfb3-button"><div class="container responsivegrid"> <div id="container-d64802dfb3" class="cmp-container"> <div class="aem-Grid aem-Grid--10 aem-Grid--default--10 "> <div class="text component-body-typography aem-GridColumn aem-GridColumn--default--10"> <div id="text-5731ce6ba7" class="cmp-text"> <p><b>Help with drug costs </b><br /> If you need help paying for your prescription drug premium or copays, check to see if you qualify for these programs. </p> <p><b>Medicare Prescription Payment Plan </b><br /> This new payment option can help you manage drug costs by spreading them across the calendar year. <a href="/plans/mppp">Read our frequently asked questions and learn how you can opt in to the program.</a> </p> <p><b>Low income subsidy</b> <br /> To see if you qualify, call <b>1-800-MEDICARE (1-800-633-4227)</b> 24 hours a day, seven days a week. Or call the Social Security Office at <b>1-800-772-1213</b> Monday–Friday, 7 a.m.–7 p.m. (TTY 1-800-325-0778). You can also call your state Medicaid office.</p> <p>If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. Learn more about Monthly Plan Premiums here: <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/CY%202025%20LIS%20Premium%20Summary%20model.pdf">2025</a> | <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/CY%202024%20LIS%20Premium%20Summary%20model.pdf" target="_blank" rel="noopener noreferrer">2024</a></p> <p><b>Pharmaceutical assistance programs </b><br /> To ask if you qualify, call: <br /> Prescription Advantage <br /> P.O. Box 15153 <br /> Worcester, MA 01615-0153 <br /> 1-800-243-4636, Monday – Friday , 9:00 AM – 5:00 PM</p> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="twocolumntextimageblock"><div class="cmp-custom-two-columt-text-image-block --white-background --grid-two-column-one-one --align-left "> <div class="cmp-custom-two-columt-text-image-block__left-column"> <div class="cmp-custom-two-columt-text-image-block__header"> <h2 class="cmp-custom-two-columt-text-image-block__title" tabindex="0">Get personal support from a pharmacist</h2> </div> <div class="cmp-custom-two-columt-text-image-block__image-container --do-not-show-image"> <img class="cmp-custom-two-columt-text-image-block__image" src="/content/dam/mgbhp/aep-25-launch/image-women_shaking_hands-01.jpg" alt="Two women shaking hands and laughing."/> </div> <div class="cmp-custom-two-columt-text-image-block__text-and-buttons"> <div class="cmp-custom-two-columt-text-image-block__text-area cmp-custom-two-columt-text-image-block__text-content"> <p tabindex="0"><p>The Medication Therapy Management Program (MTMP) is your chance to review your medications and over-the-counter products with a pharmacist. <a href="https://massgeneralbrighamadvantage.org/rx-information/mtmp?pk_vid=c4e779b1071797a6172779008102b84e">Learn more about this program</a> that is free to all Medicare members.</p> </p> </div> </div> </div> <div class="cmp-custom-two-columt-text-image-block__right-column"> <div class="cmp-custom-two-columt-text-image-block__image-container"> <img class="cmp-custom-two-columt-text-image-block__image" src="/content/dam/mgbhp/aep-25-launch/image-women_shaking_hands-01.jpg" alt="Two women shaking hands and laughing."/> </div> </div> </div> </div> <div class="text component-heading-typography primary-blue-color"> <div id="text-cedf169652" class="cmp-text"> <h2 style=" text-align: left; ">Transition your prescriptions</h2> </div> </div> <div class="text component-body-typography neutral-dark-gray-color"> <div id="text-808de15e05" class="cmp-text"> <p>Mass General Brigham Health Plans Part D Transition Policy exists to provide new (and some current) enrollees immediate access to prescription drugs within 90 days of enrollment for non-formulary drugs and drugs with utilization management requirements, such as the need for a prior authorization from us.</p> </div> </div> <div class="accordion panelcontainer"> <div id="accordion-25e2370710" class="cmp-accordion" data-cmp-is="accordion" data-placeholder-text="false"> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-25e2370710-item-4a929cb249":{"@type":"mgbhp/components/accordion/item","dc:title":"Medicare Advantage Part D Transition Fill Policy"}}" id="accordion-25e2370710-item-4a929cb249"> <h3 class="cmp-accordion__header"> <button id="accordion-25e2370710-item-4a929cb249-button" class="cmp-accordion__button" type="button" aria-controls="accordion-25e2370710-item-4a929cb249-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Medicare Advantage Part D Transition Fill Policy</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-25e2370710-item-4a929cb249-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-25e2370710-item-4a929cb249-button"><div class="container responsivegrid"> <div id="container-4a929cb249" class="cmp-container"> <div class="aem-Grid aem-Grid--10 aem-Grid--default--10 "> <div class="text component-body-typography aem-GridColumn aem-GridColumn--default--10"> <div id="text-21458afd99" class="cmp-text"> <p><b>Who is eligible for a transitional supply?</b></p> <p>A transitional supply, or transition fill, is available to members within 90 days of your enrollment effective date in the following circumstances:</p> <ul><li>Join or switch drug plans during the annual Open Enrollment Period between Oct 15-Dec 7,</li><li>Join or switch drug plans during the year using another type of enrollment period (e.g., Initial Enrollment Period, Special Enrollment Period, or Medicare Advantage Open Enrollment Period),</li><li>New and current plan members who live in long-term care (LTC) facilities, and</li><li>May be available to some current plan members who are negatively affected by formulary changes from one plan year to the next.</li></ul> <p><b>Does the transition policy apply to all drugs?</b></p> <p>The transition policy does not apply to Part D excluded drugs, new prescriptions, or to drugs that have been removed from a plan’s formulary because of FDA safety recalls. The transition policy does apply to both non-formulary drugs and drugs with utilization management requirements.</p> <p><b>What is utilization management?</b></p> <p>Utilization management (UM) is a restriction or action required by your plan before we will pay for medication. Quantity limits, step therapy, or prior authorization are common utilization management restrictions. These restrictions often require a doctor or prescriber to submit information about your medical condition or treatment before we can pay for the medication, even though the drug is on the formulary.</p> <p><b>What do I do next?</b></p> <p>You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take.</p> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="spacer"><div class="cmp-custom-spacer --small "> </div> </div> <div class="imageteaser"><div class="cmp-custom-image-teaser cmp-custom-image-teaser--left-text "> <div class="cmp-custom-image-teaser__image-container"> <img class="cmp-custom-image-teaser__image" src="/content/dam/mgbhp/aep-25-launch/image-decision_support_kit_gray-01.jpg" alt="Decision Support kit set against a gray background. 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How much do they cost?"}}" id="accordion-836d3de27e-item-3fa2f07414"> <h3 class="cmp-accordion__header"> <button id="accordion-836d3de27e-item-3fa2f07414-button" class="cmp-accordion__button" type="button" aria-controls="accordion-836d3de27e-item-3fa2f07414-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Are my medications covered? How much do they cost?</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-836d3de27e-item-3fa2f07414-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-836d3de27e-item-3fa2f07414-button"><div class="container responsivegrid"> <div id="container-3fa2f07414" class="cmp-container"> <div class="aem-Grid aem-Grid--10 aem-Grid--default--10 "> <div class="text component-body-typography aem-GridColumn aem-GridColumn--default--10"> <div id="text-5e46d6ed12" class="cmp-text"> <p>You can search our online formulary to find drugs covered by your plan and which of the five cost sharing tiers they belong to. The amount you pay depends on the drug’s tier and what stage of the benefit you have reached. You can find more information about these tiers and stages in your plan’s Summary of Benefits, located on our individual plan pages:</p> <p style=" margin-left: 40.0px; "><a href="/plans/advantage-secure-hmo">Mass General Brigham Advantage Secure (HMO-POS)</a><br /> <a href="/plans/mass-general-brigham-advantage">Mass General Brigham Advantage (PPO)</a><br /> <a href="/plans/advantage-premier-ppo">Mass General Brigham Advantage Premier (PPO)</a><br /> <a href="/plans/advantage-signature-ppo">Mass General Brigham Advantage Signature (PPO)</a></p> <p>If you need help with the cost of your medications, you may be eligible for certain state and federal programs that can help you manage costs or reduce your monthly prescription drug premium or co-pays. </p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-836d3de27e-item-8e21de1b01":{"@type":"mgbhp/components/accordion/item","dc:title":"What is your transition fill policy and who is eligible?"}}" id="accordion-836d3de27e-item-8e21de1b01"> <h3 class="cmp-accordion__header"> <button id="accordion-836d3de27e-item-8e21de1b01-button" class="cmp-accordion__button" type="button" aria-controls="accordion-836d3de27e-item-8e21de1b01-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">What is your transition fill policy and who is eligible?</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-836d3de27e-item-8e21de1b01-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-836d3de27e-item-8e21de1b01-button"><div class="container responsivegrid"> <div id="container-8e21de1b01" class="cmp-container"> <div class="aem-Grid aem-Grid--10 aem-Grid--default--10 "> <div class="text component-body-typography aem-GridColumn aem-GridColumn--default--10"> <div id="text-e2f2b90cef" class="cmp-text"> <p>The Mass General Brigham Health Plan Part D Transition Policy exists to provide new (and some current) enrollees immediate access to prescription drugs within 90 days of enrollment for non-formulary drugs and drugs with utilization management requirements, such as the need for a prior authorization from us.</p> <p>A transitional supply, or transition fill, is available to members within 90 days of your enrollment effective date in the following circumstances:</p> <ul><li>Join or switch drug plans during the Annual Enrollment Period between Oct 15-Dec 7, Join or switch drug plans during the year using another type of enrollment period (e.g., Initial Enrollment Period, Special Enrollment Period, or Open Enrollment Period from Jan 1-Mar 31),</li><li>New and current plan members who live in long-term care (LTC) facilities, and</li><li>May be available to some current plan members who are negatively affected by formulary changes from one plan year to the next</li></ul> <p>The transition policy does not apply to Part D excluded drugs, new prescriptions, or to drugs that have been removed from a plan’s formulary because of FDA safety recalls. The transition policy does apply to both non-formulary drugs and drugs with utilization management requirements.<br /> <br /> After filling a transitional supply, you should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take.</p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-836d3de27e-item-7f48b78b05":{"@type":"mgbhp/components/accordion/item","dc:title":"What is utilization management?"}}" id="accordion-836d3de27e-item-7f48b78b05"> <h3 class="cmp-accordion__header"> <button id="accordion-836d3de27e-item-7f48b78b05-button" class="cmp-accordion__button" type="button" aria-controls="accordion-836d3de27e-item-7f48b78b05-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">What is utilization management?</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-836d3de27e-item-7f48b78b05-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-836d3de27e-item-7f48b78b05-button"><div class="container responsivegrid"> <div id="container-7f48b78b05" class="cmp-container"> <div class="text component-body-typography"> <div id="text-41d142389c" class="cmp-text"> <p>Utilization management (UM) is a restriction or action required by your plan before we will pay for medication. 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