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Formulary ID: 25080

Book: 12

Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible*. Call Member Services for more information. 

Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible*.

*Please refer to your Evidence of Coverage and other plan materials for any deductible that may apply. "
 

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Formulary Id: 25080
Formulary Effective Date: 01/01/2025
Updated:
12/2024

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