Medicare Part D covers
medicines not covered
by Original Medicare.
Get protection from out-of-pocket
costs at your pharmacy.
If you're eligible for Medicare or turning 65
our Medicare Prescription Drug Plan offers you:
Low or No Copays*
LIPITOR® or CRESTOR® for $0 to $2 per month*
Nationwide network of over 64,000 pharmacies thanks to our exclusive alliance with the National Community Pharmacists Association (NCPA).
Call for a
Complimentary
Plan Guide Now!
1-800-755-1232,
TTY for the hearing impaired:
1-866-684-5351
8:00 a.m. to 8:00 p.m. in your
local time zone, 7 days a week
Annual Election Period is November 15-December 31, 2010
*Effective January 1, 2011, this low copay is for each 30-day supply during the Initial Coverage Stage.
Community CCRxSM PDP is a federally qualified Medicare contracting Prescription Drug Plan and is offered
by the following organizations that contract with the Federal government: American Progressive
Life & Health Insurance Company of New York and Pennsylvania Life Insurance Company, members of the
Universal American family of companies.The benefit information provided herein is a brief summary,
not a comprehensive description of benefits. For more information contact the plan at 1-866-684-5353 (TTY: 1-866-684-5351) 8:00 a.m. to 8:00 p.m. in your local time zone, 7 days a week. This information is available in
a different format, including Spanish. Please call Customer Service at the number listed above if
you need plan information in another format or language. Esta información está disponible en diferentes
formatos, incluyendo el español. Por favor llame a Servicio al Cliente al número indicado arriba si
necesita información del plan en otro formato u idioma. Benefits,
formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1,
2012. You must continue to pay your Medicare Part B premiums. Limitations, copayments, and
restrictions may apply. You may be able to get Extra Help to pay for your prescription drug
premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048, 24 hours a day/7 days a week : The Social Security Office at
1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or :
Your State Medicaid Office.We have formed a network of pharmacies. To receive plan prescription drug
benefits, you must use a network pharmacy, except in non-routine circumstances, and quantity limitations
and restrictions may apply. Contact Community CCRx for more information. You may enroll in the plan only during specific
times of the year. Contact Community CCRx for more information.
Y0067_Web LPPDP1_1010 CMS Approved 11/22/2010 Last Updated 10/22/2010