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  • Prescription Drugs

    PHP (HMO SNP) includes a prescription drug benefit that, like its medical benefits, is designed around the needs of people with HIV.  Two key features of the benefit is a $0 Part D premium and the plan’s formulary (drug list). (This does not include any Medicare Part B premium you may have to pay.) PHP prices antiretrovirals (ARVs) at the same cost sharing as it does for common generic drugs, something most other Medicare Advantage and prescription drug plans do not do.

    Take a look at the current 2025 Comprehensive Formulary (effective February 1, 2025; last updated January 24, 2025). PHP covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. There are generic drug substitutes available for many brand name drugs.

    For 2025, PHP has a no-cost (0% coinsurance) drug tier (Tier 5) in its prescription drug benefit that include select care drugs such as high blood pressure, cholesterol and diabetes management drugs.

    PHP’s 2025 prescription drug cost-sharing for Medicare beneficiaries who do not receive “Extra Help” (low income subsidy) from Medicare is shown below.

    Stage 1
    Yearly Deductible Stage

    Stage 2
    Initial Coverage Stage

    Stage 3
    Catastrophic Coverage Stage

    You begin in this payment stage when you fill your first prescription of the year. During this stage you pay the full cost of your tier 1 through 4 drugs.  You pay nothing for drugs on tier 5.

    You stay in this stage until you have paid $580 for your drugs ($580 is the amount of your deductible).

    The deductible does not apply to covered insulin products and most adult Part D vaccines, including shingles, tetanus and travel vaccines.

    You pay $35 per month supply of each covered insulin product.

    During this stage, you pay coinsurance for covered drugs in tiers 1 through 4 as follows:

    • Tier 1 – 15%
    • Tier 2 – 15%
    • Tier 3 – 25%
    • Tier 4 – 25%

    You pay nothing for drugs on tier 5.

    You pay $35 per month supply of each covered insulin product.

    Once you have paid $2,000 out of pocket for Part D drugs, you will move to the next stage (the Catastrophic Coverage Stage).

    During this payment stage, the plan pays the full cost for your covered Part D drugs.  You pay nothing.

     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.

    Getting Help from Medicare – If you chose this plan because you were looking for insulin coverage at $35 or less a month, it is important to know that you may have other options available to you for 2025 at even lower costs because of changes to the Medicare Part D program. Contact Medicare, at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week for help comparing your options.  TTY users should call 1-877-486-2048. 

    Additional Resources to Help – Please contact our Member Services number at (800) 263-0067 for additional information. (TTY users should call 711.)  Hours are 8:00 am to 8:00 pm, seven days a week.

    You can also see the 2025 Summary of Benefits for more information.

    If you receive “Extra Help” from Medicare, the above cost sharing does not apply to you. Your cost sharing is much lower depending on the amount of “Extra Help” you get from Medicare. 

    PHP has added benefits that Original Medicare doesn’t offer. Take a look…

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    Page Updated: February 7, 2025 @ 1:56am