March 13, 2026

We are reaching out to notify you of an upcoming change to prescription drug coverage for Jefferson Health Plans Medicare Advantage patients.

The Centers for Medicare and Medicaid Services (CMS) recently announced that the Value-Based Insurance Design (VBID) program ended on December 31, 2025. This means many Dual Special Needs plans (D-SNP) will no longer be able to offer $0 copays on all covered Part D prescriptions. This is a national change that applies to all Medicare Advantage plans.

This means many Jefferson Health Plans Medicare Advantage patients will begin paying copays for their prescription drugs starting on January 1, 2026.

Despite this change, we will continue to help members save on prescription drug costs:

• Jefferson Health Plans Special and Dual Pearl will have a 6-tier formulary, which will offer $0 copays for drugs on Tier 1 and 6. This means many maintenance prescription drugs will still have $0 copays.
• Jefferson Health Plans Select will have a 6-tier formulary, which will offer $0 copay for selected generic medications to treat high blood pressure, high cholesterol, and diabetes.

In addition, the Extra Help program can help keep prescription costs lower and patients will not pay more than the copays aligned to their level of Extra Help.

For more information on Formularies, please visit our webpage: hpplans.com/formularies.

If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 a.m. to 5:00 p.m.).

Thank you for your support in providing the highest quality of care to our members.