2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 6: What you pay for your Part D prescription drugs 171 You won’t pay more than $35 for a one-month supply of each covered insulin product regardless of the cost-sharing tier. Please see Section 9 of this chapter for more information on Part D vaccines and cost sharing for Part D vaccines. Section 7 During the Catastrophic Coverage Stage, the plan pays the full cost for your covered Part D drugs · You enter the Catastrophic Coverage Stage when your out-of-pocket costs have reached the $8,000 limit for the calendar year. Once you are in the Catastrophic Coverage Stage, you will stay in this payment stage until the end of the calendar year. During this payment stage, the plan pays the full cost for your covered drugs. You pay nothing. Section 8 Additional benefits information This part of Chapter 6 talks about limitations of our plan. 1. Medications will not be covered if prescribed by physicians or other providers who are excluded or precluded from the Medicare program participation. 2. You may refill a prescription when a minimum of seventy-five percent (75%) of the quantity is consumed based on the days supply. 3. Costs for drugs that are not covered under Part D do not count toward your Out-of-Pocket costs. Section 9 Part D Vaccines. What you pay for depends on how and where you get them Important message about what you pay for vaccines – Some vaccines are considered medical benefits. Other vaccines are considered Part D drugs. You can find these vaccines listed in the plan’s Drug List. Our plan covers most adult Part D vaccines at no cost to you even if you haven’t paid your Part D deductible. Refer to your plan’s Drug List or contact Customer Service for coverage and cost sharing details about specific vaccines. There are two parts to our coverage of Part D vaccinations: · The first part of coverage is the cost of the vaccine itself. · The second part of coverage is for the cost of giving you the vaccine. (This is sometimes called the “administration” of the vaccine.) Your costs for a Part D vaccination depend on three things: 1. Whether the vaccine is recommended for adults by an organization called the Advisory Committee on Immunization Practices (ACIP). - Most adult Part D vaccinations are recommended by ACIP and cost you nothing. 2. Where you get the vaccine.