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.


2019 Copayment Amounts


Elite D 2019 Copayment Amounts

Annual Description Deductible

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

Initial Coverage

During this stage, the plan pays its share of the cost of your Tier 1 and Tier 2 drugs and you pay your share of the cost.

After you (or others on your behalf) have met your Tier 3, Tier 4, and Tier 5 deductible, the plan pays its share of the costs of your Tier 3, Tier4, and Tier 5 drugs and you pay your share.

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.

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 - $4
      • Three-month (90 day) supply - $12
    • Mail Order Pharmacy
      • Three-month (90 day) supply - $4

       

    • 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 - $12

         

      • 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 an 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

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

          Initial Coverage

          During this statge, the plan pays its share of the cost of your Tier 1 and Tier 2 drugs and you pay your share of the cost.

          After you (or others on your behalf) have met your Tier 3, Tier 4, and Tier 5 deductible, the plan pays its share of the costs of your Tier 3, Tier 4 and Tier 5 drugs and you pay your share.

          You stay in this state until your year-to-date: "Total drug costs" (your payments plus any Part D plan's payments) total $3,820.

          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 - $4
              • Three-month (90 day) supply - $12
            • Mail Order Pharmacy
              • Three-month (90 day) supply - $4

               

            • 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 - $12

                 

              • 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

                  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
                  This webpage was updated on January 2, 2019.