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


2019 UW Health Elite D Copayment Amounts

Annual Description Deductible

There is no deductible.

Initial Coverage

You begin in this stage when you fill your first prescription of the year. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. 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.

Mail order pharmacy copayment amounts are also noted below.

  • 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

          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.

          2019 UW Health Value D Copayment Amounts

          Annual Description Deductible

          There is no deductible.

          Initial Coverage

          You begin in this stage when you fill your first prescription of the year. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. 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.

          Mail order pharmacy copayment amounts are also noted below.

          • 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

                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 web page was updated on January 2, 2019.