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 Gundersen Minnesota 2018

Annual Description Deductible

  • There is no Part D prescription deductible.

Initial Coverage

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.

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 - $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 - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113
  • 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 33% 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 33% 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 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 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 Gundersen Minnesota 2018

Annual Description Deductible

  • There is no Part D prescription deductible.

Initial Coverage

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.

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 - $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 - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113
  • 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 33% 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 33% 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.


2017 Copayment Amounts


Elite D - 2017 Copayment Amounts

Annual Description Deductible

  • There is no Part D prescription 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.

  • 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 - $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 - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113
  • 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 33% 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 33% 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 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.

Value D - 2017 Copayment Amounts

Annual Description Deductible

  • There is no Part D prescription deductible.

Initial Coverage

Before the total yearly drug costs (paid by both you and Senior Preferred Value 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.

  • 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 - $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 - $45
      • Three-month (90 day) supply - $135
    • Mail Order Pharmacy
      • Three month (90 day) supply - $113
  • 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 33% 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 33% 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 Value 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.