Benefit Overview ® Express Scripts Medicare (PDP) YOUR 2025 PRESCRIPTION DRUG PLAN BENEFIT Here is a summary of what you will pay for covered prescription drugs across the different stages of your Medicare Part D benefit. You can fill your covered prescriptions at a network retail pharmacy or through our home delivery service. Prescription Drug Plan Option 1: Deductible stage $590.00 Initial After you pay your yearly deductible: You will pay the following until your total yearly drug costs (what Coverage you and the plan pay) reach $2,000: stage Tier Retail Retail Home Delivery One-Month Three-Month Three-Month (31-day) Supply (90-day) Supply (90-day) Supply (Standard) Tier 1: 15% 15% 10% Generic Drugs Tier 2: 30% 30% 25% Preferred Brand Drugs Tier 3: 30% 30% 30% Non- Preferred Brand Tier 4: 25% 25% 25% Specialty If your doctor prescribes less than a full month’s supply of certain drugs, you will pay a daily cost-sharing rate based on the actual number of days of the drug that you receive. You may receive up to a 90-day supply of certain maintenance drugs (medications taken on a long-term basis) by mail through the Express Scripts PharmacySM. There is no charge for standard shipping. Not all drugs are available at a 90-day supply, and not all retail pharmacies offer a 90-day supply. Non-part D Drugs Covered; Excluding lifestyle Compound Compound Management Solution applies. Compound Management Solution is in place to mitigate compound drug abuse by means of inclusion and exclusion lists Catastrophic After your yearly out-of-pocket drug costs reach $2,000, you will pay $0.00 Coverage stage