Pharmacy Partnerships

Simplete streamlines relationships with pharmacies to help lower costs for you by having a pharmacy network.

You must use an in-network pharmacy to get covered drugs unless it’s an emergency. For a list of in-network pharmacies, view our pharmacy directory at simplete.org/medicare, or request a copy using the card in the back of this guide.

Save with Simplete.

Every opportunity to save money is important, especially when it comes to prescriptions. That’s why Simplete offers special savings programs to help you lower the cost of your medications. Here are some of the ways you can save with Simplete:

No Pharmacy Deductible – All Part D plans begin with full benefits immediately. There is no pharmacy deductible you have to meet first.

90-Day Supply Savings – Limit your trips to the pharmacy with two convenient options. With our mail-order benefit, you can get a 90-day supply of your drugs delivered directly to you for two copays. If you prefer to get your drugs at a retail pharmacy, you can visit any in-network pharmacy and get a 90-day supply for three copays. Medication Therapy Management – If you take multiple medications, our complimentary Medication Management Service helps you use them safely and effectively.

Financial Assistance – You may be eligible to receive financial assistance for your prescriptions through the Extra Help program. To see if you qualify, call one of the following:

• (800) MEDICARE (800-633-4227), 24 hours a day, seven days a week (TTY 877-486-2048). • The Social Security Administration at (800) 772-1213, 7 a.m. to 7 p.m., Monday through Friday (TTY 800-325-0778). • The Medicaid office for your state.

Drugs We Cover All the drugs covered by Simplete plans are included in what we call a formulary. The Simplete formulary packet is included with this booklet. You can also find the formulary online to search for your prescription and estimate your costs for the year at simplete.org/medicare. COSTS IN THE INITIAL COVERAGE PERIOD

Simplete 1 (HMO) Simplete 2 (HMO) Simplete 3 (HMO-POS)

30-DAY DRUG COST BY TIER

Tier 1 - $2 Tier 2 - $15 Tier 3 - $47 Tier 4 - 50% Tier 5 - 33%

Catastrophic Coverage

This coverage begins when your out-of-pocket drug costs reach $7,050. At this stage, we pay for most of your drug costs for the rest of the year, while you pay the greater of the following: • 5% of the cost. • $3.95 for the covered generic drugs. (Including brand-name drugs treated as generic). • $9.85 for the covered brand-name drugs. Coverage Gap This begins when the amount you pay plus the amount we pay for your prescription drugs reaches $4,430. At this stage, you pay: • 25% for covered generic drugs. • 25% for covered brand-name drugs.

Initial Coverage This begins when the amount you pay plus the amount we pay for your prescription drug reaches $4,430.

Coverage Through the Gap If your total prescription spend adds up to $4,430, you’ll reach the coverage gap. With your Simplete plan, you’ll continue to pay your copay for Tier 1 medications until your out-of-pocket expenses reach $7,050.

Caring About You

Feeling like just a number in a system? That was the old way. Now there’s a new way. Simplete includes wellness perks and a care coordination team to help you live a healthy lifestyle.