*Some drugs are limited to a30-day supply 12 Summary of Benefits H5619075000SB23 H5619075000 To find out if you qualify for "Extra Help," please contact the Social Security Office at 1-800-772-1213  
Monday —Friday, 7a.m. —7p.m. TTY users should call 1-800-325-0778. For more information on  
pharmacy-specific cost-sharing, please call us or refer to Chapter 6of the Evidence of Coverage for more  
details.  
If you reside in along-term care facility, you pay the same as at aretail pharmacy.