Know your Rx benefits
If you have a stand-alone Medicare Part D prescription drug plan or a Medicare Advantage plan with prescription drug coverage, there are a lot of benefits you can get through your plan. We’ve outlined some of them here.
1. Understanding your pharmacy network and costs
Some pharmacies in our network contract with us to offer lower cost-sharing to plan members with prescription drug coverage. This is known as preferred pharmacy cost-sharing. At a preferred pharmacy, you will pay $0 for Tier 1 preferred generic drugs and NEW for 2025! Tier 2 generic drugs. You will pay coinsurance (a percentage of the full cost of a drug) for Tier 3, Tier 4, and Tier 5 drugs. To find a preferred pharmacy near you, visit our Find a Pharmacy tool at ibxmedicare.com/pharmacyfinder.
Or have your prescriptions delivered right to your door by signing up for our mail-order service through OptumRx® Home Delivery. To get started with mail order, log in or register at ibx.com/login or call 1-888-678-7015 (TTY/TDD: 711), seven days a week, 24 hours a day.
Preferred pharmacies:
- CVS
- Giant
- Rite Aid
- ShopRite
- Target
- Wegmans
- Other independent pharmacies
2. Limit out-of-pocket spending
Besides using preferred pharmacies or mail order, you can save on prescription drug costs through the Low-Income Subsidy (LIS) or “Extra Help” program. This program helps people with limited income and assets pay for prescription drugs and other Part D costs. Medicare has raised the annual income limit, allowing more people to qualify in 2025 for LIS benefits, such as no Part D deductibles, no Part D premiums, and a cost cap on certain drugs. To see if you qualify and apply for Extra Help, visit ssa.gov/extrahelp.
3. Annual Part D out-of-pocket (OOP) threshold
Medicare is setting a maximum amount you will pay out of pocket for your prescription drugs. In 2025, that amount will be $2,000. This means that after your out-of-pocket spending reaches $2,000, you won’t pay anything for your prescription drugs for the rest of the year in 2025. The cap does not apply to drugs covered under Medicare Part B.
4. A new way to pay for your prescription drugs
After October 15, 2024, anyone with prescription drug coverage will have the option to opt in to the Medicare Prescription Payment Plan.
This is a monthly payment plan that allows you to no longer pay when you pick up your prescriptions at the pharmacy or receive your mail-order delivery. The payment plan won’t lower your total drug costs, but it can help you manage them.
Opting in is completely voluntary. Once you have out-of-pocket prescription costs, you will get a monthly bill from us. This will continue as long as you remain part of the Medicare Prescription Payment Plan.
OptumRx is an Optum® company, an independent company that provides home delivery pharmacy services. Other pharmacies are available in our network.
