Drug Maintenance –

Senior Preferred allows members to fill their medications in a supply greater than 30 days. We allow up to a 90-day supply per fill for drugs within tiers 1-4. Each 30-day supply will take one copay (a 90-day supply equals 3 copays) at a retail pharmacy.

See the mail order page for information on getting a better copayment through the mail order program.

Scroll down to view 2018 Copayment Amounts.


2019 Copayment Amounts


Elite D 2019 Copayment Amounts

Annual Description Deductible

  • There is no Part D prescription deductible.

Initial Coverage

You begin in this stage when you fill your first prescription of the year. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. You stay in this stage until your year-to-date: “total drug costs” (your payments plus any Part D plan’s payments) total $3,820.
 

Mail Order Pharmacy copayment amounts are also noted below.

  • Tier 1 - (Preferred Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $3
      • Three-month (90 day) supply - $9
    • Mail Order Pharmacy
      • Three-month (90 day) supply - $7

     

  • Tier 2 - (Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $15
      • Three-month (90 day) supply - $45
    • Mail Order Pharmacy
      • Three month (90 day) supply - $38

     

  • Tier 3 - (Preferred Brand) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113

     

  • Tier 4 - (Non-Preferred Drug) Coinsurance Amounts
    • Retail Pharmacy
      • One-month (30 day) supply - You pay 40% of the cost.
      • Three-month (90 day) supply - You pay 40% of the cost.
    • Mail Order Pharmacy
      • Three month (90 day) supply - You pay 40% of the cost.

     

  • Tier 5 - (Specialty Medications) Copayment Amounts
    • Retail Pharmacies
      • One-month (30 day) supply - You pay 33% of the cost.
      • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies.
    • Mail Order Pharmacy
      • One-month (30 day) supply - You pay 33% of the cost. 
      • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

 

If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

Coverage Gap

During this stage, you pay 25% of the price for brand name drugs (plus a portion of the dispensing fee) and 37% of the price for generic drugs. You stay in this stage until your year-to-date “out-of-pocket costs” (your payments) reach a total of $5,100. This amount and rules for counting costs toward this amount have been set by Medicare.

Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $5,100, you pay the greater of 5% of the drug cost or $3.40 copay for generic drugs or $8.50 for brand drugs.

Value D - 2019 Copayment Amounts

Annual Description Deductible

  • There is no Part D prescription deductible.

Initial Coverage

You begin in this stage when you fill your first prescription of the year. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. You stay in this stage until your year-to-date: “total drug costs” (your payments plus any Part D plan’s payments) total $3,820.

Mail Order Pharmacy copayment amounts are also noted below.


  • Tier 1 - (Preferred Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $3
      • Three-month (90 day) supply - $9
    • Mail Order Pharmacy
      • Three-month (90 day) supply - $7

     

  • Tier 2 - (Generic) Copayment Amounts
    • Retail Pharmacy
      • One-month (30 day) supply - $15
      • Three-month (90 day) supply - $45
    • Mail Order Pharmacy
      • Three month (90 day) supply -$38

     

  • Tier 3 - (Preferred Brand) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113

     

  • Tier 4 - (Non-Preferred Drug) Coinsurance Amounts
    • Retail Pharmacy
      • One-month (30 day) supply - You pay 40% of the cost.
      • Three-month (90 day) supply - You pay 40% of the cost.
    • Mail Order Pharmacy
      • Three month (90 day) supply - You pay 40% of the cost.

     

  • Tier 5 - (Specialty Medications) Coinsurance Amounts
    • Retail Pharmacies
      • One-month (30 day) supply - You pay 33% of the cost.
      • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies.
    • Mail Order Pharmacy
      • One-month (30 day) supply - You pay 33% of the cost.
      • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

 

If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

Coverage Gap

During this stage, you pay 25% of the price for brand name drugs (plus a portion of the dispensing fee) and 37% of the price for generic drugs. You stay in this stage until your year-to-date  “out-of-pocket costs” (your payments) reach a total of $5,100. This amount and rules for counting costs toward this amount have been set by Medicare.

Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $5,100, you pay the greater of 5% of the drug cost or $3.40 copay for generic drugs or $8.50 for brand drugs

2018 Copayment Amounts


Elite D - 2018 Copayment Amounts

Annual Description Deductible

  • There is no Part D prescription deductible.

Initial Coverage

Before the total yearly drug costs (paid by both you and Senior Preferred Elite D) reach $3,750, you pay the following amounts for prescription drugs when they are filled at a retail pharmacy. You may get your drugs at network mail order pharmacies

Mail Order Pharmacy copayment amounts are also noted below.

  • Tier 1 - (Preferred Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $3
      • Three-month (90 day) supply - $9
    • Mail Order Pharmacy
      • Three-month (90 day) supply - $7

     

  • Tier 2 - (Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $15
      • Three-month (90 day) supply - $45
    • Mail Order Pharmacy
      • Three month (90 day) supply - $38

     

  • Tier 3 - (Preferred Brand) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113

     

  • Tier 4 - (Non-Preferred Drug) Coinsurance Amounts
    • Retail Pharmacy
      • One-month (30 day) supply - You pay 40% of the cost.
      • Three-month (90 day) supply - You pay 40% of the cost.
    • Mail Order Pharmacy
      • Three month (90 day) supply - You pay 40% of the cost.

     

  • Tier 5 - (Specialty Medications) Copayment Amounts
    • Retail Pharmacies
      • One-month (30 day) supply - You pay 33% of the cost.
      • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies.
    • Mail Order Pharmacy
      • One-month (30 day) supply - You pay 33% of the cost. 
      • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

 

If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

Coverage Gap

After your total yearly drug costs (paid by both you and Senior Preferred) reach $3,750, you receive limited coverage by the plan on certain drugs. You will be responsible for 35% of the total cost for brand name drugs and 44% of the total cost for generic drugs until your yearly out-of-pocket drug costs reach $5,000.

Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of 5% of the drug cost or $3.35 copay for generic drugs or $8.35 for brand drugs.

Value D - 2018 Copayment Amounts

Annual Description Deductible

  • There is no Part D prescription deductible.

Initial Coverage

You pay the following until your total yearly drug costs reach $3,750. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.

You may get your drugs at network mail order pharmacies.

Mail Order Pharmacy copayment amounts are also noted below.

  • Tier 1 - (Preferred Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $3
      • Three-month (90 day) supply - $9
    • Mail Order Pharmacy
      • Three-month (90 day) supply - $7

     

  • Tier 2 - (Generic) Copayment Amounts
    • Retail Pharmacy
      • One-month (30 day) supply - $15
      • Three-month (90 day) supply - $45
    • Mail Order Pharmacy
      • Three month (90 day) supply -$45

     

  • Tier 3 - (Preferred Brand) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113

     

  • Tier 4 - (Non-Preferred Drug) Coinsurance Amounts
    • Retail Pharmacy
      • One-month (30 day) supply - You pay 40% of the cost.
      • Three-month (90 day) supply - You pay 40% of the cost.
    • Mail Order Pharmacy
      • Three month (90 day) supply - You pay 40% of the cost.

     

  • Tier 5 - (Specialty Medications) Coinsurance Amounts
    • Retail Pharmacies
      • One-month (30 day) supply - You pay 33% of the cost.
      • We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies.
    • Mail Order Pharmacy
      • One-month (30 day) supply - You pay 33% of the cost.
      • We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

 

If you reside in a long-term care facility, you pay the same as at a retail pharmacy.

You may get drugs from at out-of-network pharmacy, but you may pay more than you pay at an in-network pharmacy.

Coverage Gap

After your total yearly drug costs (paid by both you and Senior Preferred) reach $3,750, you receive limited coverage by the plan on certain drugs. You will be responsible for 35% of the total cost for brand name drugs and 44% of the total cost for generic drugs until your yearly out-of-pocket drug costs reach $5,000.

Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $5,000, you pay the greater of 5% of the drug cost or $3.35 copay for generic drugs or $8.35 for brand drugs.

This webpage was updated on October 1, 2018.