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.
Pharmacy benefits built for
savings and convenience
Our Medicare Advantage prescription drug coverage includes hundreds of
generic and brand-name medications, all with no deductible.
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.
2025 pharmacy information
2024 pharmacy information
If you need more pharmacy information, you can find drug coverage and pharmacy forms on our Forms & Resources page.
For Employer Group Waiver Plans (EGWPs)
Did you know? Members get $0 preferred
generic drugs at pharmacies nationwide
Commonly used generic medications in Tier 1 of our Formulary are covered at no additional cost to
members. Talk to your doctor to see if these medications may be right for you.
Convenient
pharmacy access
Members have access to thousands of participating pharmacies, including all major pharmacy chains.
Medicare Part D Coverage Details - 2025
Initial coverage period
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.
Reaching the Catastrophic Coverage Limit
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.
Rx information for members
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.
Transitional supplies are available to some members within 90 days of their enrollment effective date. See our frequently asked questions for more details.
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: 2025 | 2024
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
Get personal support from a pharmacist
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.
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.
Our Plans
We designed our plans to provide continuous coverage so that you can always get the right care, at the right time. Each one of our plans offers comprehensive benefits like vision, dental, hearing, and fitness reimbursements - all starting from $0 monthly.
Frequently asked questions
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:
Mass General Brigham Advantage Secure (HMO-POS)
Mass General Brigham Advantage (PPO)
Mass General Brigham Advantage Premier (PPO)
Mass General Brigham Advantage Signature (PPO)
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.
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.
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 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),
- 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
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.
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.
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.
© 2024 Mass General Brigham Health Plan, Inc. Mass General Brigham Health Plan is an HMO-POS/PPO organization with a Medicare contract. Enrollment in Mass General Brigham Health Plan depends on contract renewal. Other providers/pharmacies are included in our network.
Y0166_0860MKT_M2025A
Last updated: 10/1/2024 - Pending CMS approval