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Aspirus Health Plan Medicare Part D prescription drug coverage 

What is Part D prescription drug coverage?  

Medicare Part D helps cover costs for your outpatient prescription drugs and some vaccines that aren't covered under Medicare Part A or Part B. Medicare Part D drug plans offer a formulary (list of covered drugs) with set copays. Most plans with Part D have a monthly premium, benefits and drug costs that vary by plan. As of January 1, 2025, your out-of-pocket drug costs won’t exceed $2,000. Once you hit that amount in annual drug spending (excluding Aspirus’ amount), you pay $0.

Tools and tips to get your medications 

Find an in-network pharmacy  

In order for your prescription drugs to be covered by your health plan, make sure to get them from in-network pharmacies. Use our search tool to find a pharmacy in your health plan’s network.

Find an in-network pharmacy

Mail order pharmacy

To skip the trip to the pharmacy, fill your prescriptions through Costco Mail Order Pharmacy or one of your health plan’s other in-network mail order pharmacies.

Mail order pharmacy

Search the Medicare formulary 

Also known as the list of covered drugs or drug list, a formulary is a list of drugs, chosen by a team of doctors and pharmacists, that are covered by your health plan. You can also access your prior authorization and formulary exception criteria documents online as you browse the formulary.

Search the formulary

Fill your prescriptions

Once you’ve found an in-network pharmacy, you can choose from three ways to fill your prescription:

  • Have your doctor send your prescription to a pharmacy in your plan network
  • Take the written prescription to a pharmacy in your plan network
  • Use Costco Mail Order Pharmacy

Get help managing your drug costs 

Extra Help 

You may qualify for Extra Help, a Medicare program that helps pay for your Medicare Part D prescription drug plan costs, monthly premium, coinsurance, deductible and more. The amount of Extra Help you get will determine your total Part D monthly premium as a member of our plan. The Aspirus Health Plan Part D premium includes coverage for both medical services and prescription drug coverage in many plan options. You can find out if you qualify for Extra Help by calling:

You can also find information on the Medicare and Social Security Administration websites.

2025 Extra Help program premiums

The information below shows your 2026 Aspirus Health Plan monthly Part D plan premium if you get Extra Help. This does not include any Medicare Part B premium you may have to pay.

Essential Rx: $0.00

Medicare Prescription Payment Plan 

The Medicare Prescription Payment Plan is available to members with Part D coverage. This program will allow you to manage your out-of-pocket Part D prescription drug costs by spreading them out across the plan year instead of paying at the pharmacy. You’re most likely to benefit from participating in the Medicare Prescription Payment Plan if you have high drug costs earlier in the calendar year.

Learn more

Pharmacy resources and programs

View your pharmacy claims

You can easily review your pharmacy claims in your claims history on your health plan’s online member account. Log in to your online member account to view and track your claims.

Log in to your account

Get an extended-day supply

With Medicare Part D coverage, you can get up to 100-day supplies of qualifying drugs at your local, in-network pharmacy or at Costco Mail Order Pharmacy. To take advantage of this, talk with your pharmacist or doctor about extended day refills. Find network pharmacies near you with our pharmacy search tool

Medication Therapy Management 

We offer one-on-one visits with a pharmacist and provide tools to help you better manage your medications — at no additional cost to you. You may receive a call from an Aspirus Health Plan pharmacist to help manage multiple medicines or help after a hospital discharge.
Learn more about Medication Therapy Management

Personalized medication adherence calls

You may receive a call or text from a Aspirus Health Plan pharmacy team member or a representative from Navitus’ Clinical Engagement Center (CEC) to help manage your prescription drugs. A pharmacist, nurse or pharmacy technician may call to check in and offer support with your pharmacy-related needs. There is no additional cost for these services.

Best Available Evidence policy

The Centers for Medicare & Medicaid Services (CMS) created this policy to address incorrect LIS benefit information reflected in their data systems and ensure that Medicare beneficiaries aren't overcharged for their prescriptions.
Learn and download more information on the policy

Coverage determinations, appeals and grievances

The Medicare program has established rules about what you need to do to make a complaint about Part D services or benefits. Find out how to make a complaint if you have concerns about your Part D coverage.
Learn more about coverage determinations, appeals and grievances

Find important documents  

Prescription Drug Claim Form (PDF)

Request for Medicare Prescription Drug Coverage Determination Form (PDF)

Request for Redetermination of Medicare Prescription Drug Denial Form (PDF)

Prescription Drug Transition Policy (PDF)

Questions?  

Please call customer service at 715.631.7411 or 1.855.931.4850 toll-free 
TTY 1.855.931.4850 
8 am – 8 pm, seven days a week

This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.