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.
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:
Commonly used generic medications in Tier 1 of our Formulary are covered at no additional cost to members.
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
2025 pharmacy documents
2026 pharmacy documents
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.
Medicare Part D Coverage Details
- 2025 coverage details
- 2026 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
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.
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Get personal support from a pharmacist
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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.
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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.
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Mass General Brigham One Care is a Dual Special Needs Plan (D-SNP) that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone age 21 - 64 who qualifies for MassHealth Standard or CommonHealth and Original Medicare and does not have any other comprehensive health insurance, except Medicare.
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Mass General Brigham SCO (Senior Care Options) is a Dual Special Needs Plan (D-SNP) with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health insurance, except Medicare.
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Last updated: 10/1/2025
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