At EmblemHealth, we offer Medicare plans that cover a wide range of prescription drugs. Below is a complete list of all covered drugs in our comprehensive formularies. This list includes both generic and brand-name drugs. Most formularies list drugs in levels or “tiers”, based on cost. The lower the level or tier, the lower your cost for the drug will be.
The Medicare Prescription Payment Plan is a new payment option for 2025 that works with your current Part D drug coverage to help you manage your out-of-pocket prescription costs by spreading them across the calendar year (January through December). Those who have high cost-share amounts for prescription drugs earlier in the plan year are more likely to benefit from the program. This voluntary program is free to join and there are no fees or interest charged under the payment plan.
This option doesn’t save you money or lower your maximum out-of-pocket drug cost ($2,000 in 2025). If you receive extra help paying for prescription drugs or have low drug costs, this payment option is not the best choice for you. Learn more about Extra Help here.
The following resources provide examples of how the payment is calculated and tell you about other ways to save on prescription drug costs:
You can also calculate your monthly payment plan amounts here.
Contact ExpressScripts to opt in or out of the program.
If you are new to the plan, we will process your request within:
If you are currently a member:
You must pay your monthly payments to stay enrolled. If you do not pay within a grace period of two months, we will remove you from the Medicare Prescription Payment Plan.
For information on how to file a complaint and grievance, please click here.
Find out how to set up home delivery or get a prescription refill.
Find out if you qualify for this service, which is free for EmblemHealth Medicare plan members with Part D prescription drug coverage.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances.
Last Updated 10/01/2024
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