Pharmacy benefits built for savings and convenience

Our Medicare Advantage prescription drug coverage includes hundreds of
generic and brand-name medications.

Get to know our Medicare Advantage pharmacy benefits

Our plans include Part D prescription drug coverage, making it easy to manage your prescription needs and expenses with one health plan. They also include additional pharmacy benefits, such as:

$0 generic drugs



Commonly used generic medications in Tier 1 of our Formulary are covered at no additional cost to members.

100-day supplies



A long-term (100-day) supply of medications is available for select maintenance drugs in Tiers 1-4, with a prescription from your physician. Check the formulary below to see if your medications are eligible. Federal and state laws and regulations may apply.

Members can access these benefits by signing in to the Member Portal. Members can also contact Member Services to access these benefits. 

Check your prescription drug coverage

See if your current medications are covered by searching our online formulary.

 

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.

2026 pharmacy documents

Coming soon
Coming soon

For Employer Group Waiver Plans (EGWPs) 

For Mass General Brigham Medicare Rx Group (PDP)

Convenient
pharmacy access

Members have access to thousands of participating pharmacies, including all major pharmacy chains.
 

Pharmacist checking her tablet inside a pharmacy.

Medicare Part D Coverage Details

Transition your prescriptions

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. You can learn more about this policy below.

Who is eligible for a transitional supply?

A transitional supply, or transition fill, is available to members within 90 days of your enrollment effective date in the following circumstances:

  • Join or switch drug plans during the annual Open 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 Medicare Advantage Open Enrollment Period),
  • New and current plan members who live in long-term care (LTC) facilities, and
  • May be available to some current plan members who are negatively affected by formulary changes from one plan year to the next.

Does the transition policy apply to all drugs?

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.

What is utilization management?

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.

What do I do next?

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.

Help with drug costs

If you need help paying for your prescription drug premium or copays, check to see if you qualify for these programs.



Medicare Prescription Payment Plan

This new payment option can help you manage drug costs by spreading them across the calendar year. Read our frequently asked questions and learn how you can opt in to the program.

Low income subsidy
To see if you qualify, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week. Or call the Social Security Office at 1-800-772-1213 Monday–Friday, 7 a.m.–7 p.m. (TTY 1-800-325-0778). You can also call your state Medicaid office.

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.

Pharmaceutical assistance programs

To ask if you qualify, call:

Prescription Advantage 

P.O. Box 15153 

Worcester, MA 01615-0153 

1-800-243-4636, Monday – Friday , 9:00 AM – 5:00 PM

Part B Medical Service Drugs Requiring Prior Authorization (PDF)
These drug requests are submitted to Mass General Brigham Health Plan.



Part B Medical Drugs Requiring Prior Authorization
Prior authorization is required for the drugs listed within this document when being administered using the member’s medical Part B benefit. Requests for the drugs in this document should be submitted to Novologix.

Part B Medical Drugs Requiring Prior Authorization Guidelines

Transition your prescriptions

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. You can learn more about this policy below.

Who is eligible for a transitional supply?

A transitional supply, or transition fill, is available to members within 90 days of your enrollment effective date in the following circumstances:

  • Join or switch drug plans during the annual Open 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 Medicare Advantage Open Enrollment Period),
  • New and current plan members who live in long-term care (LTC) facilities, and
  • May be available to some current plan members who are negatively affected by formulary changes from one plan year to the next.

Does the transition policy apply to all drugs?

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.

What is utilization management?

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.

What do I do next?

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.

Help with drug costs

If you need help paying for your prescription drug premium or copays, check to see if you qualify for these programs.



Medicare Prescription Payment Plan

This new payment option can help you manage drug costs by spreading them across the calendar year. Read our frequently asked questions and learn how you can opt in to the program.

Low income subsidy
To see if you qualify, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week. Or call the Social Security Office at 1-800-772-1213 Monday–Friday, 7 a.m.–7 p.m. (TTY 1-800-325-0778). You can also call your state Medicaid office.

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.

Pharmaceutical assistance programs

To ask if you qualify, call:

Prescription Advantage 

P.O. Box 15153 

Worcester, MA 01615-0153 

1-800-243-4636, Monday – Friday , 9:00 AM – 5:00 PM

Part B Medical Service Drugs Requiring Prior Authorization (PDF) Coming soon. 
These drug requests are submitted to Mass General Brigham Health Plan.



Part B Medical Drugs Requiring Prior Authorization Coming soon.
Prior authorization is required for the drugs listed within this document when being administered using the member’s medical Part B benefit. Requests for the drugs in this document should be submitted to Prime Therapeutics.

Get personal support from a pharmacist

Two women shaking hands and laughing.

The Medication Therapy Management Program (MTMP) is your chance to review your medications and over-the-counter products with a pharmacist. Learn more about this program that is free to all Medicare members.

Get personal support from a pharmacist

The Medication Therapy Management Program (MTMP) is your chance to review your medications and over-the-counter products with a pharmacist. Learn more about this program that is free to all Medicare members.

Our plans

We designed our plans to provide continuous coverage that helps you get the care you need, when you need it. Each of our plans offers comprehensive benefits like vision, dental, hearing, and fitness reimbursements - all starting from a $0 monthly premium.

Have questions?

Ask a Medicare Advisor

Our dedicated Medicare Advisors are here to help. They can answer questions about forms, policies, and coverage.

Call 855-486-3097

TTY 711

Oct 1 - Mar 31

8 AM-8 PM ET, Mon-Sun

Apr 1 - Sep 30

8 AM-8 PM ET, Mon-Fri