Learn About Your Plan

Simply Prescriptions offers low monthly premiums, a nationwide network of thousands of participating pharmacies, and Medicare-dedicated customer service representatives who are always there to help.

Generally, you must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply. Open the 'Network Pharmacies' tab below to learn more.

Plan Costs

Ask your employer about the monthly premium you'll pay. You must continue to pay for your Medicare Part B premium.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If qualify, Medicare could pay for up to seventy five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

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. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

Levels of extra help
100%
75%
50%
25%

 

* This does not include any Medicare Part B premium you may have to pay.

If you aren't getting extra help, you can see if you qualify by calling:

If you have any questions, please call Customer Care toll-free at 1-800-514-6930 (TTY/TDD 1-800-662-1220) 8 a.m. to 8 p.m., Monday – Friday. From Oct. 1 to Mar. 31, representatives will be available seven days a week from 8 a.m. to 8 p.m.

Do you believe you have qualified for extra help and that you are paying an incorrect copayment amount?

If you believe you are paying an incorrect copayment amount when you get your prescription at the pharmacy, we can help you confirm your eligibility. Simply Prescriptions follows Medicare's Best Available Evidence Policy and if you have the appropriate documentation, we can help you sort out your eligibility issues. Call Customer Care toll-free at 1-800-514-6930 (TTY/TDD 1-800-662-1220) 8 a.m. to 8 p.m., Monday – Friday. From Oct. 1 to Mar. 31, representatives will be available seven days a week from 8 a.m. to 8 p.m.

What is Best Available Evidence?

Medicare's Best Available Evidence Policy is used to determine eligibility for extra help with prescription drug costs when information is not readily available to us through other standard sources. This policy allows you, your representative, pharmacist, advocate, family member or other individual acting on your behalf to submit certain documentation that we will use to update your eligibility when appropriate.


Permissible documents are as follows:

  • A copy of a member's Medicaid card that includes his or her name and an eligibility date during a month after June of the previous calendar year;
  • A copy of a State document that confirms active Medicaid status during a month after June of the previous calendar year;
  • A print out from the State electronic enrollment file showing Medicaid status during a month after June of the previous calendar year;
  • A screen print from the State's Medicaid systems showing Medicaid status during a month after June of the previous calendar year;
  • Other documentation provided by the State showing Medicaid status during a month after June of the previous calendar year;
  • A copy of the SSA Award letter

To establish that you are a full benefit dual eligible individual, institutionalized and qualify for a zero cost-sharing level, we will accept any one of the following forms of proof:

  • A remittance from the facility showing Medicaid payment for a full calendar month for you during a month after June of the previous calendar year;
  • A copy of a State document that confirms Medicaid payment on your behalf to the facility for a full calendar month after June of the previous year; or
  • A screen print from the State's Medicaid systems showing your institutional status based on at least a full calendar month stay for Medicaid payment during a month after June of the previous calendar year.

For additional assistance on where to send your documents, please call Customer Care toll-free at 1-800-514-6930 (TTY/TDD 1-800-662-1220) 8 a.m. to 8 p.m., Monday – Friday. From Oct. 1 to Mar. 31, representatives will be available seven days a week from 8 a.m. to 8 p.m.

Follow this link to view Medicare's Best Available Evidence Policy. You will be taken to the Centers for Medicare and Medicaid Services (CMS) Web site.

Generally, you must use network pharmacies to get your prescription drugs covered, except under non-routine circumstances, and quantity limitations and restrictions may apply. We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

  • If the prescriptions are related to care for a medical emergency or urgently needed care.
  • If you are unable to get a covered prescription drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service.
  • If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).

In these situations, please check first with our Customer Care department to see if there is a network pharmacy nearby.

  • View our 2024 Pharmacy DirectoryOpen a PDF
     

  • Thousands of pharmacies participate in our nationwide network. A network pharmacy is a pharmacy that has contracted to participate in our network to provide your covered prescription drugs. Our pharmacy network includes retail, mail order, long-term care, home infusion and Indian/Tribal/Urban pharmacies. Our pharmacy network may change on January 1 of each year. To obtain a list of network pharmacies, to find out if your pharmacy is in our network, or to get order forms and information about filling your prescriptions by mail, call Customer Care toll-free at 1-877-883-9577 (TTY/TDD 1-800-662-1220) 8 a.m. to 8 p.m., Monday - Friday. From Oct. 1 to Mar. 31, representatives will be available seven days a week from 8 a.m. to 8 p.m.

This information is not a complete description of benefits. Call 1-877-883-9577 (TTY/TDD 1-800-662-1220) for more information.

If you need information in another format, please call Customer Care toll-free at 1-877-883-9577 (TTY/TDD 1-800-662-1220) 8 a.m. to 8 p.m., Monday - Friday. From Oct. 1 to Mar. 31, representatives will be available seven days a week from 8 a.m. to 8 p.m.

Simply Prescriptions contracts with the Federal Government and is a PDP plan with a Medicare contract. Enrollment in Simply Prescriptions depends on contract renewal. Submit feedback about your Medicare prescription drug plan at www.Medicare.gov or by contacting the Medicare Ombudsman. _.

This page last updated 10-01-2023.

 

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