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Prescription Drug Plan

Part D Benefits Only

2020CommunityCare Prescription Drug Plan001 Information and Descriptions
Premium $20.80 per month
Deductible $425 - doesn't apply to Tier 1 Drugs
30 day supply Preferred Pharmacy Standard Pharmacy
Tier 1: Preferred Generic $0 $8
Tier 2: Generic $6 $16
Tier 3: Preferred Brand 10% 25%
Tier 4: Non-Preferred Drug 25% 25%
Tier 5: Specialty Tier 25% 25%

Important Notes:

Every year Medicare evaluates plans based on a 5-star rating system. You can see the Prescription Drug Plan Star Rating by clicking on the link above.

Part D plans are designed to provide you with outpatient prescription drug coverage. Your health coverage is through Original Medicare. Remember that if you enroll in a Medicare Advantage plan – with or without Part D, you will be disenrolled from your CommunityCare Part D Prescription Drug Plan.

If you have questions about enrolling in a plan that includes prescription drug coverage, please call us at 918-594-5275 [TTY/TDD 1-800-722-0353].

Service Area

Although Medicare is a Federal program, CommunityCare Prescription Drug Plan is available only to individuals who live in our plan service area. To stay a member of our plan, you must keep living in this service area.

The CommunityCare Prescription Drug Plan service area includes: State of Oklahoma

If you plan to move out of the service area, please contact Customer Service at 918-594-5202 or 1-800-333-3275. TTY/TDD users should call 1-800-722-0353.

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