Drug Maintenance –

Prescriptions are often sold in 30-day supplies. However, you can buy up to a 90-day supply if you have tier 1-4 medications that you use regularly. Each 30-day supply will take one copay (a 90-day supply equals three copays) at a retail pharmacy.

If you live in a long-term care facility, your copay is the same as in a retail pharmacy.

You can get prescriptions from an out-of-network pharmacy, but you may pay more.

Want to save money?

The mail order program may offer lower copays for your medications.


2020 Copayment Amounts


 

Elite D / Value D / Core D
Retail Copayments

Elite D / Value D / Core D
Mail Order Copayments

Annual Description Deductible

No Part D deductible.No Part D deductible.
Tier 1 (Preferred Generic)

One-month (30 day) supply - $3

Three-month (90 day) supply - $9

Three-month (90 day) supply - $7
Tier 2 (Generic)

One-month (30 day) supply - $15

Three-month (90 day) supply - $45

Three month (90 day) supply - $38
Tier 3 (Preferred Brand)

One-month (30 day) supply - $45

Three-month (90 day) supply - $135

Three month (90 day) supply - $113
Tier 4 (Non-Preferred Drug)

One-month (30 day) supply - 40% of cost

Three-month (90 day) supply - 40% of cost

Three month (90 day) supply - 40% of cost
Tier 5 (Specialty Medications)

One-month (30 day) supply - 33% of cost

We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies.

One-month (30 day) supply - 33% of cost

We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.


2019 Copayment Amounts


 

Elite D and Value D
Retail Copayments

Elite D and Value D
Mail Order Copayments

Annual Description Deductible

No Part D deductible.No Part D deductible.
Tier 1 (Preferred Generic)

One-month (30 day) supply - $3

Three-month (90 day) supply - $9

Three-month (90 day) supply - $7
Tier 2 (Generic)

One-month (30 day) supply - $15

Three-month (90 day) supply - $45

Three month (90 day) supply - $38
Tier 3 (Preferred Brand)

One-month (30 day) supply - $45

Three-month (90 day) supply - $135

Three month (90 day) supply - $113
Tier 4 (Non-Preferred Drug)

One-month (30 day) supply - 40% of cost

Three-month (90 day) supply - 40% of cost

Three month (90 day) supply - 40% of cost
Tier 5 (Specialty Medications)

One-month (30 day) supply - 33% of cost

We do not cover three-month (90 day) supplies of Tier 5 medications at retail pharmacies.

One-month (30 day) supply - 33% of cost

We do not cover three-month (90 day) supplies of Tier 5 medications through mail order pharmacy.

Coverage Gap

Most Medicare drug plans have a coverage gap every year.

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.

Out of the Coverage Gap and into 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.

This webpage was updated on October 1, 2019.