All SummaCare Medicare Advantage plans (except the Amber (HMO) plan) include Medicare (Part D) prescription drug coverage for no additional monthly plan premium. You can see the complete plan formulary (list of covered drugs) or use our Find Your Drug tool to search for a specific drug.
The SummaCare Medicare Formulary is a list of covered drugs under SummaCare Medicare Advantage plans. SummaCare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy (except in non-routine circumstances) and other plan rules are followed.
SummaCare covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as brand name drugs.
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.
The formulary and pharmacy network may change at any time. You will receive notice when necessary.
Check to see if your drug is covered
If you enroll in SummaCare and notice your drug is not included in the SummaCare Medicare Formulary, contact us to confirm your drug is not covered.
SummaCare will cover your prescriptions at in-network pharmacies under the applicable co-payment amount while you travel throughout the United States. Our pharmacy network includes most national chains, plus many local, independent pharmacies. If traveling, your out-of-pocket costs may be higher if you fill a prescription at an out-of-network pharmacy.
In general, you must use in-network pharmacies to access your prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply.
Search for a network pharmacy.
Our plan groups each medication into one of six “tiers.” The amount you pay depends on the drug’s tier and what stage of the benefit you have reached. Tier 1 preferred generic drugs and Tier 6 Select Care Drugs (includes Vaccines) are covered at a $0 copay. Tier 2 is also covered at $0 copay for Emerald, Sapphire, Ruby and Topaz plans.
Some common generic over-the-counter (OTC) drugs are covered at a $0 copay if prescribed by a doctor.
There are three possible drug payment stages for your prescription drug coverage under SummaCare Medicare. How much you pay depends on what stage you are in when you get a prescription filled or refilled. Details of each stage can be found below. The stages are:
If your plan has a deductible, you must pay this first. For instance, you must pay the full cost of your tier 3 and tier 4 drugs until you reach the plan's deductible amount. The deductible does not apply to covered insulin products and most adult Part D vaccines.
During this stage, the plan pays its share of the cost of your covered prescription drugs, and you pay your share (your applicable copayment or coinsurance). You stay in this stage until your out-of-pocket costs reach $2000.
Once you reach this stage, you pay $0 for all covered Part D medications for the remainder of the plan year.
Use our online search to find out what drugs are covered and/or locate what tier your drug is in to determine how much it will cost you.
View the SummaCare Medicare drug list, learn how our mail-order pharmacy can save you money and find out what drugs have quantity limits, step therapy or prior authorization requirements.