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

Initial Coverage 

Before the total yearly drug costs (paid by both you and Senior Preferred Elite D) reach $3,700, you pay the following amounts for prescription drugs when they are filled at a retail pharmacy.

Mail order pharmacy copayment amounts are also noted below.

Initial Coverage

  • Tier 1 - (Preferred Generic) Copayment Amounts   
    • Retail Pharmacy
      • One-month (30 day) supply - $6
      • Three-month (90 day) supply - $18
    • Mail Order Pharmacy
      • Three-month (90 day) supply - $15

       

    • 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 - $47
          • Three-month (90 day) supply - $141
        • Mail Order Pharmacy
          • Three month (90 day) supply - $118

           

        • Tier 4 - (Non-Preferred Brand Name) Copayment 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 25% 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 25% 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

          Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,750.

          After you enter the coverage gap, you pay 35% of the plan’s cost for covered brand name drugs and 44% of the plan’s cost for covered generic drugs until your costs total $5,000 which is the end of the coverage gap. Not everyone will enter the coverage gap.

          Catastrophic Coverage

          After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $5,000 you pay the greater of:

          • 5% of the cost or

          • $3.35 copay for generic (including brand drugs treated as generic) and $8.35 copay for all other drugs.

          2018 UW Health Value D Copayment Amounts

          Annual Description Deductible

          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.

          Initial Coverage

          • Tier 1 - (Preferred Generic) Copayment Amounts   
            • Retail Pharmacy
              • One-month (30 day) supply - $6
              • Three-month (90 day) supply - $18
            • Mail Order Pharmacy
              • Three-month (90 day) supply - $15
            • 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 - $47
                • Three-month (90 day) supply - $141
              • Mail Order Pharmacy
                • Three month (90 day) supply - $118

                 

              • Tier 4 - (Non-Preferred Brand Name) Copayment 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 25% 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 25% 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

                Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $3,750.

                After you enter the coverage gap, you pay 35% of the plan’s cost for covered brand name drugs and 44% of the plan’s cost for covered generic drugs until your costs total $5,000 which is the end of the coverage gap. Not everyone will enter the coverage gap.

                Catastrophic Coverage

                After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $5,000 you pay the greater of:

                • 5% of the cost or
                • $3.35 copay for generic (including brand drugs treated as generic) and $8.35 copay for all other drugs.

                2017 Copayment Amounts


                Elite D - 2017 Copayment Amounts

                Annual Description Deductible

                Initial Coverage 

                Before the total yearly drug costs (paid by both you and Senior Preferred Elite D) reach $3,700, you pay the following amounts for prescription drugs when they are filled at a retail pharmacy.

                Mail order pharmacy copayment amounts are also noted below.

                Initial Coverage

                • Tier 1 - (Preferred Generic) Copayment Amounts   
                  • Retail Pharmacy
                    • One-month (30 day) supply - $6
                    • Three-month (90 day) supply - $18
                  • Mail Order Pharmacy
                    • Three-month (90 day) supply - $15

                     

                  • 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 - $47
                        • Three-month (90 day) supply - $141
                      • Mail Order Pharmacy
                        • Three month (90 day) supply - $118

                         

                      • Tier 4 - (Non-Preferred Brand Name) Copayment 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 25% 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 25% 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 Elite D) 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.

                        Value D Plan 2017

                        Annual Description Deductible

                        Initial Coverage 

                        Before the total yearly drug costs (paid by both you and Senior Preferred Elite D) reach $3,700, you pay the following amounts for prescription drugs when they are filled at a retail pharmacy.

                        Mail order pharmacy copayment amounts are also noted below.

                        Initial Coverage

                        • Tier 1 - (Preferred Generic) Copayment Amounts   
                          • Retail Pharmacy
                            • One-month (30 day) supply - $6
                            • Three-month (90 day) supply - $18
                          • Mail Order Pharmacy
                            • Three-month (90 day) supply - $15
                          • 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 - $47
                                • Three-month (90 day) supply - $141
                              • 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 25% 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 25% 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 $3,700, 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 web page was updated on October 27, 2017.