2026 Drug Plan Changes

Diabetic supplies will be covered at the same benefit levels as other covered drugs and supplies. Copayments may vary.

For most plans, preferred diabetic supplies will fall under Tier 2 copay and non-preferred diabetic supplies will fall under Tier 3 copay.

Commercial Fed87 and Postal Plans (excluding Postal PDP) will also process at point of sale. Refer to the plan brochure.

Immunizations when processed by pharmacy will be billable through point of sale under the drug plan.

Immunizations administered and dispensed by other providers will still be a medical benefit.

Commercial Fed87 and Postal Plans (not Postal PDP) will also process at point of sale. Refer to Plan brochure.

Specialty drugs will move from copayment-based cost shares to coinsurance-based cost shares. The member’s copayment for Tier 4 Specialty Drugs will change to 20% of the eligible charge. For members who have Tier 5 Specialty Drug benefits, their copayment will change to 25% of the eligible charge.

Commercial Fed87 and Postal Plans (not Postal PDP) will also process at point of sale. Refer to Plan brochure.

Other Supplies –

(Disposable CGMS / Disposable Insulin Pumps)

A new benefit for Other Supplies will be added to cover supplies listed in the plan’s Drug Formulary, such as diabetic equipment. The member’s copayments will be as follows for up to a 30-day supply: 20% of eligible charge with participating providers; 30% of eligible charge with non-participating providers. A contracted provider for maintenance prescriptions (up to a 90-day supply) will have a 20% of eligible charge cost-share.

Commercial Fed87 and Postal Plans (not Postal PDP) will also process at point of sale. Refer to Plan brochure.