Drug tiers for 2017

The higher a drug's cost level or "tier," the higher the cost. In the chart below, you'll see what you'll pay for each drug tier for a 30-day supply at a network pharmacy and for up to a 90-day supply through mail order.

The copayments we show below apply:
  • After you pay your prescription deductible, if your plan has one
  • Before you reach $3,700 in total drug costs (total of what you pay plus what Priority Health pays).
  • Costs may vary when your plan is provided by an employer.

Drug tier cost sharing for 2017

Copays shown are your cost for a 30-day supply at a retail pharmacy and for up to a 90-day supply through mail order in the Priority Health network, before you reach $3,700 in total drug costs (total of what you pay plus what Priority Health pays). Costs may vary when your plan is provided by an employer.

PriorityMedicare Key℠

Tier 1
Preferred generic
Tier 2
Non-preferred generic
Tier 3
Preferred brand name
Tier 4
Non-preferred brand name
Tier 5
Specialty
After you meet the $400 deductible: 25% coinsurance

PriorityMedicare Ideal℠

Tier 1
Preferred generic
Tier 2
Non-preferred generic
Tier 3
Preferred brand name
Tier 4
Non-preferred brand name
Tier 5
Specialty
After you meet the $400 deductible: 25% coinsurance

PriorityMedicare Value℠

Tier 1 Preferred generic Tier 2 Non-preferred generic Tier 3 Preferred brand name Tier 4 Non-preferred brand name Tier 5 Specialty
After you meet the $75 deductible:
$2 (30-day)
$6 (90-day mail order)
After you meet the $75 deductible:
$10 (30-day)
$30 (90-day mail order)
After you meet the $75 deductible:
$42 (30-day)
$126 (90-day mail order)
After you meet the $75 deductible:
$95 (30-day)
$285 (90-day mail order)
After you meet the $75 deductible:
31% of Priority Health discounted cost (30-day supply only)

PriorityMedicare Merit℠

Tier 1 Preferred generic Tier 2 Non-preferred generic Tier 3 Preferred brand name Tier 4 Non-preferred brand name Tier 5 Specialty
$2 (30-day)
$6 (90-day mail order)
$10 (30-day)
$30 (90-day mail order)
After you meet the $75 deductible:
$42 (30-day)
$126 (90-day mail order)
After you meet the $75 deductible:
$95 (30-day)
$285 (90-day mail order)
After you meet the $75 deductible:
31% of Priority Health discounted cost (30-day supply only)

The $75 deductible does not apply to preferred generic or generic drugs. It applies to the first $75 of your costs for drugs from tiers 3, 4 and 5.

PriorityMedicare℠

Tier 1
Preferred generic
Tier 2
Non-preferred generic
Tier 3
Preferred brand name
Tier 4
Non-preferred brand name
Tier 5
Specialty
$1 (30-day)
$3 (90-day mail order)
$8 (30-day)
$24 (90-day mail order)
$38 (30-day)
$114 (90-day mail order)
$93 (30-day)
$249 (90-day mail order)
33% of Priority Health discounted cost (30-day supply only)

PriorityMedicare Select℠

Tier 1
Preferred generic
Tier 2
Non-preferred generic
Tier 3
Preferred brand name
Tier 4
Non-preferred brand name
Tier 5
Specialty
$1 (30-day)
$3 (90-day mail order)
$8 (30-day)
$24 (90-day mail order)
$38 (30-day)
$114 (90-day mail order)
$93 (30-day)
$249 (90-day mail order)
33% of Priority Health discounted cost (30-day supply only)