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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 | Elite D / Value D / Core D |
|---|---|---|
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 | Elite D and Value D |
|---|---|---|
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.