Prescription Drug Coverage

If you enroll in the HOP Medical Plan or the Value Medical Plan (Medicare Supplement plans), you can enroll in the Enhanced Medicare Rx Option, the Basic Medicare Rx Option, or the Value Medicare Rx Option.

Note: You can enroll in these options on a stand-alone basis if you don’t want medical coverage. However, you will not be eligible for Premium Assistance.

If you select a Medicare Advantage plan, your prescription drug coverage is provided with your medical coverage. You cannot select a separate prescription drug coverage option.

Enhanced Medicare Rx Option

  • No deductible 
  • Pays the least of the three options for certain medications
  • Includes coverage of certain medications not covered at all under the other two options or Medicare prescription drug programs offered by commercial carriers (see the Bonus Drug List in the back of the formulary)
  • Higher premiums than those for the Basic and Value Medicare Rx Options because the Plan provides greater coverage
  • Enhanced Medicare Rx Option benefit overview (PDF 40KB)

Basic Medicare Rx Option

  • Annual $100 prescription drug deductible (does not apply to generic drugs)
  • Lower level of coverage than the Enhanced Medicare Rx Option for certain medications
  • Basic Medicare Rx Option benefit overview (PDF 40KB)

Value Medicare Rx Option

  • Lowest monthly premium of all three options
  • Must satisfy Medicare’s $545 annual deductible (in 2024) before Plan pays any portion of your prescription drug expenses
  • Financial protection in the event of unexpected high-cost prescription drug expenses
  • After you meet the annual deductible, you pay 25% of the cost of any medication in Initial Coverage.
  • Value Medicare Rx Option benefit overview (PDF 39KB)
Compare your options

Download the Medicare Rx Options Comparison Chart (PDF 52 KB) for a side-by-side comparison of all three Medicare Rx Options.

Also review the formulary (list of covered drugs). The Enhanced and Basic Medicare Rx Options have the same formulary. The Value Medicare Rx Option uses a different formulary. There are certain medications that are covered only under the Enhanced Medicare Rx Option (see the Bonus Drug List in the back of the formulary).

Find a drug or pharmacy

Use the tools below to search for drugs by name, tier, or therapeutic class. Note: If you’re enrolled in a Medicare Advantage plan, the drug formulary for that Plan will be different. Check with your Plan for the most updated formulary.

Enhanced and Basic Medicare Rx Options

Value Medicare Rx Option

Exceptions and Appeals

We encourage you to let us know right away if you have questions, concerns, or problems related to the Enhanced, Basic, or Value Medicare Rx Options. Please call our Customer Service numbers as follows:

  • For questions regarding the Enhanced, Basic, or Value Rx Options, including the formulary, prior authorizations, mail service orders, Explanation of Benefits (EOB), or the cost of individual drugs, please call OptumRx at 1-888-239-1301.
  • For questions regarding eligibility, monthly premium payments, identification cards, or changes in address, please call the HOP Administration Unit at 1-800-773-7725.

A summary of Appeals and Grievances regarding the Medicare prescription drug plans follows. For more details, see the applicable Annual Notice of Changes and the Evidence of Coverage posted to the Documents and Forms page.

Federal law guarantees your right to make complaints if you have concerns or problems with any part of your care as a participant of a Medicare Rx plan. Making a complaint will not affect your participation in this Plan in any way. A complaint will be handled as either a coverage determination, an appeal, or a grievance, depending on the subject of the complaint. The following sections describe each type of complaint.

Reporting Fraud

The Medicare prescription drug benefit was implemented by the Centers for Medicare & Medicaid Services (CMS) to allow all Medicare beneficiaries access to prescription drug coverage beginning on January 1, 2006.

Medicare is interested in receiving reports of potential fraud, waste, or abuse from Medicare beneficiaries. 

If you have a general question or concern related to your Medicare drug benefit and it is not a potential fraud, waste, or abuse issue, please contact the HOP Administration Unit at 1-800-773-7725 or call 1-800-Medicare. You may also contact the PSERS fraud, waste, or abuse hotline at 1-800-778-2703 or 717-772-3883.

Last Modified: May 28, 2024

Prescription drug coverage resources