Compass Rose Medicare Prescription Drug Plan (PDP) EGWP

Maximize the value of your prescription drug benefits with the Compass Rose Medicare Prescription Drug Plan (PDP) EGWP. The Medicare PDP EGWP is a Part D plan that helps eligible members save on prescriptions. This is just one way we’re making your Compass Rose Health Plan coverage and Medicare work together for you.

Eligible members entitled to Medicare Part A and/or enrolled in Medicare Part B and not enrolled in Compass Rose Medicare Advantage will be auto-enrolled during Open Season. Coverage will begin the following plan year.

With Compass Rose Medicare PDP EGWP You Get:

The same Compass Rose benefits you’re used to
Lower out-of-pocket costs under each drug tier
A more expansive 90-day retail pharmacy network
An annual prescription drug cap of $2,000

Medicare PDP EGWP Out-of-Pocket Costs

Enjoy lower medication costs under each drug tier and an annual pharmacy out-of-pocket maximum of $2,000, separate from your medical out-of-pocket maximum. Plus, you’ll get access to a more expansive 90-day retail pharmacy network, allowing you to get a 90-day supply of your medications at more pharmacy locations, in addition to CVS and Walgreens.

What you can expect to pay for covered medications in 2025 under the Medicare PDP EGWP.
Tier	Retail (30-day supply)	Mail Order or Retail (90-day supply)
Tier 1 – Generic	$1	$2
Tier 2 – Formulary/Preferred Brand Name	$25	$50
Tier 3 – Non-Formulary/Non-Preferred Brand Name	$50	$100
Tier 4 – Specialty	25% up to a maximum of $75	25% up to a maximum of $75 (limited to a 30-day supply)

Pharmacy Out-of-Pocket Maximum

A unique benefit of the Medicare PDP EGWP is that you will have a separate annual pharmacy out-of-pocket maximum of $2,000. An out-of-pocket maximum is a cap on the amount you’ll pay on prescription drugs for the year. Once you reach the maximum for the year, you pay nothing for your prescriptions for the rest of the year.

You still have a separate medical out-of-pocket maximum of $3,000. Your Medicare PDP EGWP pharmacy out-of-pocket maximum is not added to it.

Check your current drug costs

With the Optum Rx® Drug Pricing Tool, you can see if your drug is covered under your plan and what you would pay out-of-pocket with and without the Medicare PDP EGWP. Please note 2025 pricing information will be available on the tool starting November 1, 2024.

Go to Optum Rx

Auto Enrollment Process

Every year in the fall, the Compass Rose Health Plan will automatically enroll eligible members who are:

Entitled to Medicare Part A and/or enrolled in Medicare Part B
Not enrolled in Compass Rose Medicare Advantage

If you meet the above criteria, you will receive an eligibility letter in the mail prior to enrollment. Coverage will begin the following plan year.

You can opt out if you don’t want the Compass Rose Medicare PDP EGWP. If you opt out, you will remain in the traditional High Option pharmacy benefit and will not be auto enrolled in the future.

To opt out, call Optum Rx at (844) 368-0690 or mail or fax a signed disenrollment request to:

Optum Rx Enrollment Services
Attn: Enrollment Services
PO Box 269027 Fort Lauderdale, FL 33326
Fax: 1-800-784-1580

Information on your rights and responsibilities is available in your evidence of coverage.

Questions? Contact Optum Rx

Call Optum Rx toll free at (844) 368-0690 8 a.m. to 11 p.m. ET, 7 days a week, except holidays.

Frequently Asked Questions

Income-Related Monthly Adjustment Amount (IRMAA)
Depending on your income, you may need to pay an Income Related Monthly Adjustment Amount (IRMAA) for the Compass Rose Medicare PDP. IRMAA is an amount Social Security determines you may need to pay in addition to your monthly Part B and D premium if your modified adjusted gross income on your IRS tax return from 2 years ago is above a certain limit. Although you will not have an additional premium, the Medicare PDP is considered a Part D plan. Therefore, if you currently have or would be subject to a part B IRMAA, then you may incur an additional part D IRMAA when enrolling in this plan. Learn more at medicare.gov.