Manage your SilverScript Prescription Benefits

The formulary is the list of drugs covered by the Medicare Part D portion of your plan. The formulary does not include medications covered through the additional coverage provided by Pfizer.

Medications are grouped into one of three tiers on the drug list:

• Generic (Tier 1) – Most cost-effective medications to buy. The active ingredients in generic medications are exactly the same as the active ingredients in brand medications whose patents have expired. They are required by the Food and Drug Administration (FDA) to be as safe and effective as the brand medication.
• Preferred Brand (Tier 2) – Brand medications that do not have a generic equivalent and are included on a preferred drug list. They are usually available at a lower cost than Non-Preferred Brand medications.
• Non-Preferred Brand (Tier 3) – Brand medications that are not on a preferred drug list and usually are a high cost.

View the formulary on the Documents page to find out the tier for your medication or if there are any restrictions on your medication. The formulary may change throughout the year.

View plan documents

For the Rx Plus option, the additional coverage provided by Pfizer covers most Pfizer-brand medications without a generic equivalent at no cost to you. The list of Pfizer medications provided at no cost is subject to change without notice.

SilverScript does not cover all medications that can be covered by Medicare on its formulary. In addition, there are medications that Medicare will not allow to be covered on a Medicare Part D plan. The additional coverage provided by Pfizer on the Rx Plus plan will cover certain medications that are not on the SilverScript formulary and certain medications that are excluded by Medicare Part D. Medications provided through your additional coverage provided by Pfizer may be added or removed, or restrictions may be added or changed during the year.

The cost of these medications will not count towards your Medicare Part D out-of-pocket costs or Medicare Part D total drug costs. However, the cost of these additional medications will count toward your Pfizer individual annual prescription drug out-of-pocket maximum. Please contact SilverScript Customer Care if you have any questions about your additional coverage from Pfizer.

You must use a network pharmacy to have your coinsurance count toward your Medicare Part D out-of-pocket cost and Medicare Part D total drug cost, unless it is an emergency or non-routine circumstance. The coinsurance percentage will count toward your Pfizer out-of-pocket maximum, except where noted below.

You may use an out-of-network pharmacy. However, the price of the medication may be higher than the same medication at a network pharmacy. If you are in the Rx Plus option, you may need to pay part of the cost for most Pfizer-brand medications without a generic equivalent.

If you use an out-of-network pharmacy, you will have to pay the full cost of the medication at the pharmacy, complete a paper claim form and send it and your itemized receipt to SilverScript to request reimbursement. You will be reimbursed the plan’s share of the cost for your medication. You may need to pay part of the cost, even for most Pfizer-brand medications without a generic equivalent, and the additional cost will not be applied to your Pfizer annual out-of-pocket maximum.

If you may need to get your prescription filled while you are traveling outside the country, contact SilverScript Customer Care before you leave the U.S. You can request a vacation override for up to a 90-day supply of your medication.

The pharmacies in the network can change at any time. To find a preferred or standard network pharmacy near your home or where you are traveling in the United States or its territories, use the Pharmacy Locator Tool or call SilverScript Customer Care.

Please note: Veterans Affairs (VA) pharmacies are not permitted to be part of a Medicare Part D pharmacy network. The federal government does not allow you to receive benefits from more than one government program at the same time.

If you are eligible for VA benefits, you may still use VA pharmacies under your VA benefits. However, the cost of those medications and what you pay out-of-pocket will not count toward your Medicare Part D out-of-pocket costs or Medicare Part D total drug costs. Each time you get a prescription filled, you can compare your Pfizer benefit through SilverScript to your VA benefit to determine the best option for you.