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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.

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Formulary Id: 25265

Formulary Effective Date: 01/01/2025

Updated:

10/2024

CMS Approval Date:

01/01/2025

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