Chemotherapy drugs 20% of the cost 20% of the cost 
Other Part Bdrugs 20% of the cost 20% of the cost 
Prescription Drug Benefits 
PRESCRIPTION DRUGS 
Important Message About What You Pay for Vaccines 
Our plan covers most Part Dvaccines at no cost to you, no matter what cost-sharing tier it’s on ,even if 
you haven’t paid your deductible .
Important Message About What You Pay for Insulin 
You won’t pay more than $35 for aone-month (up to 30-day) supply of each Part Dinsulin product