The Part D Formulary has five cost-sharing tiers. If you need to be on a higher cost (higher-tiered) medication because a lower cost (lower-tiered) medication did not work for you, we will consider a request to lower your copayment to the Preferred Copayment amount. 

Drug Maintenance - Senior Preferred also allows members to fill their Tier 1, Tier 2, Tier 3 or Tier 4 drugs in a supply greater than 30 days. We allow up to a 90 day supply per fill for drugs within these four tiers. Each 30-day supply will take one copay (90 days supply equals 3 copays).


2018 Copayment Amounts


Elite D - 2018 Copayment Amounts

Annual Description Deductible

  • $250 (applies to Tiers 3, 4 and 5)

Initial Coverage

After you pay your yearly deductible of $250 (brand name drugs in Tier 3, Tier 4 or Tier 5 only), 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.

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 - $12
        • Three-month (90 day) supply - $36
      • Mail Order Pharmacy
        • Three month (90 day) supply - $30

         

      • Tier 3 - (Preferred Brand) Copayment Amounts   
        • Retail Pharmacy
          • One-month (30 day) supply - $47
          • Three-month (90 day) supply - $141
        • Mail Order Pharmacy
          • Three month (90 day) supply - $118

           

        • Tier 4 - (Non-Preferred) 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 28% 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 28% 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

          • $250 (applies to Tiers 3, 4 and 5)

          Initial Coverage

          After you pay your yearly deductible of $250 (brand name drugs in Tier 3, Tier 4 or Tier 5 only), 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 retail pharmacies.

          • 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 - $12
                • Three-month (90 day) supply - $36
              • Mail Order Pharmacy
                • Three month (90 day) supply - $30

                 

              • Tier 3 - (Preferred Brand) Copayment Amounts   
                • Retail Pharmacy
                  • One-month (30 day) supply - $47
                  • Three-month (90 day) supply - $141
                • Mail Order Pharmacy
                  • Three month (90 day) supply - $118

                   

                • Tier 4 - (Non-Preferred Brand Name) 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 28% 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 28% 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 an 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 $4,9505,000 you pay the greater of 5% of the drug cost or $3.305 copay for generic drugs (including brand drugs treated as generic) andor $8.325 for allbrand other drugs.

                  2017 Copayment Amounts


                  2017 Elite D

                  Annual Description Deductible

                  • $250 (applies to Tiers 3, 4 and 5)

                  Initial Coverage

                  After you pay your yearly deductible of $250 costs (brand name drugs in Tier 3, Tier 4 or Tier 5 only), you pay the following until your total yearly drug costs reach $3,700. 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 retail pharmacies.

                  Mail Order Pharmacy copayment amounts are also noted below

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

                    Mail Order Pharmacy

                    • Three-month (90-day) supply - $7
                     
                  • Tier 2 - (Generic) Copayment Amounts
                    Retail Pharmacy
                    • One-month (30 day) supply - $12 copay
                    • Three-month (90 day) supply - $36 copay

                    Mail Order Pharmacy

                    • Three month (90 day) supply - $30

                     

                  • Tier 3 - (Preferred Brand) Copayment Amounts
                    Retail Pharmacy
                    • One-month (30 day) supply - $47 copay
                    • Three-month (90 day) supply - $141 copay

                    Mail Order Pharmacy

                    • Three month (90 day) supply - $118

                     

                  • 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 28% 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 28% 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 an out-of-network pharmacy, but you may pay more than you pay in an in-network pharmacy.

                  Coverage Gap

                  After your total yearly drug costs (paid by both you and Senior Preferred EliteD) reach $3,700, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 40% for the plan's costs for brand name drugs and 51% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,950.

                  Catastrophic Coverage

                  After your yearly out-of-pocket drug costs reach $4,950 you pay the greater of 5% of the cost or $3.30 copay for generic (including brand drugs treated as generic) and $8.25 for all other drugs

                  2017 Value D

                  Annual Description Deductible

                  • $250 (applies to Tiers 3, 4 and 5)

                  Initial Coverage

                  After you pay your yearly deductible of $250 costs (brand name drugs in Tier 3, Tier 4 or Tier 5 only), you pay the following until your total yearly drug costs reach $3,700. 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 retail pharmacies.

                  Mail Order Pharmacy copayment amounts are also noted below

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

                    Mail Order Pharmacy

                    • Three-month (90-day) supply - $7
                     
                  • Tier 2 - (Generic) Copayment Amounts
                    Retail Pharmacy
                    • One-month (30 day) supply - $12 copay
                    • Three-month (90 day) supply - $36 copay

                    Mail Order Pharmacy

                    • Three month (90 day) supply - $30

                     

                  • Tier 3 - (Preferred Brand) Copayment Amounts
                    Retail Pharmacy
                    • One-month (30 day) supply - $47 copay
                    • Three-month (90 day) supply - $141 copay

                    Mail Order Pharmacy

                    • Three month (90 day) supply - $118

                     

                  • 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 28% 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 28% 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 an out-of-network pharmacy, but you may pay more than you pay in an in-network pharmacy.

                  Coverage Gap

                  After your total yearly drug costs (paid by both you and Senior Preferred) reach $3,700, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 40% for the plan's costs for brand name drugs and 51% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,950.

                  Catastrophic Coverage

                  After your yearly out-of-pocket drug costs reach $4,950 you pay the greater of 5% of the cost or $3.30 copay for generic (including brand drugs treated as generic) and $8.25 for all other drugs

                  This webpage was updated on October 1, 2017