b'AARP Medicare Supplement Insurance Plan F (UnitedHealthcare) with Express Scripts Medicare (PDP) for CTPF Available to Medicare recipients who turned 65 prior to 2020. BEHAVIORAL HEALTH SERVICES(Medicare covered services only)Outpatient: 100% after Medicare paysPlan Comparison:Inpatient: 100% after Medicare paysMedicare - EligiblePRESCRIPTION DRUG BENEFITSPreferred Value Network Pharmacy* Members (up to 31-Day supply)$10Generic copay$30Preferred brand copay$50Non-preferred brand copay$50Specialty drugsPreferred Value Network Pharmacy* (up to 90-Day Supply)$25Generic copay$75Preferred brand copay$125Non-preferred brand copay $125Specialty drugs Express Scripts Mail Order (up 90-Day Supply)$20 Generic copay$60 Preferred brand copay$100Non-preferred brand copay $100Specialty drugs CoveragePrescription coverage is provided through the coverage gap and generally stays the same as the copays listed above.INFO Non-Medicare Part D drugs are not covered (for example, lifestyle drugs for ED). Prescription Drug Plan Changes Medicare Part B drugs, including diabetic supplies, are Each health insurance plan utilizes a formularyprocessed by your medical plan. (a list of preferred prescription drugs).Vaccinations Formularies may change annually, so makeFlu shots and shots to prevent pneumococcal sure you review your plans 2023 formularyinfections are covered under Part B. Contact your to determine if your prescription expensesMedicare drug plan for more information about will change.vaccines.Important Pharmacy NotesOnce your true out-of-pocket cost reaches $7,400, your copay may be reduced. Once you meet this cost threshold, you pay the greater of 5% coinsurance or $4.15 for generics/multi source drugs, $10.35 for brand *Non-preferred network copays are $5name drugs, but never more than the normal copay for more than stated copaysthat drug tier based on the number of days prescribed (e.g., 31 days).36 CTPF 2023 HEALTH INSURANCE HANDBOOKCTPF 2023 HEALTH INSURANCE HANDBOOK'