their plan's specific transportation provider. 
MEDICARE PART BDRUGS 
Chemotherapy drugs $0 copay 
Other Part Bdrugs $0 copay 
Prescription Drug Benefits 
PRESCRIPTION DRUGS 
Medicare Part DDrugs See chart below for plan coverage information for 
prescription drugs 
$0 Rx Copay Benefit If you qualify for "Extra Help", you will pay  $0 for all Medicare Part Dcovered 
prescription drugs on your formulary, for all tiers, and through all stages.  
Pharmacy options 
Mail Order Mail Order cost-sharing