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2017 DRUG COPAYMENT AMOUNTS

This page contains prescription drug copayment amounts for Elite D and Value D.

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 (excluding medications that, by law, do not allow pharmacies to fill in a larger quantities). Each 30-day supply will take one copay (90 days supply equals 3 copays). Because some medications may require a new written prescription, we suggest that you talk with your pharmacist.

Elite D - 2017 Copayment Amounts

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
      • 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) 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 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 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

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
      • 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) 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 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 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.


This webpage was updated on September 27, 2016.