What to do when your drug is covered

Learn about drug tiers (how much you'll pay) and requirements for prescription drugs covered by your Medicare Advantage plan.

Find out what your drug will cost: Drug tier cost sharing 2018

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 preferred retail pharmacy, at a standard pharmacy and for 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 $3,750 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 KeySM

Tier 1
Preferred generic
Tier 2
Generic
Tier 3
Preferred brand
Tier 4
Non-preferred drug
Tier 5
Specialty
$5 (preferred retail)
$10 (standard retail)
$12.50 (90-day mail order)
$15 (preferred retail)
$20 (standard retail)
$37.50 (90-day mail order)
$42 (preferred retail)
$47 (standard retail)
$105 (90-day mail order)
45% coinsurance (preferred retail)
50% coinsurance (standard retail)
45% coinsurance (90-day mail order)
30% coinsurance

PriorityMedicare IdealSM

Tier 1
Preferred generic
Tier 2
Generic
Tier 3
Preferred brand
Tier 4
Non-preferred drug
Tier 5
Specialty
$4 (preferred retail)
$9 (standard retail)
$10 (90-day mail order)
$13 (preferred retail)
$18 (standard retail)
$32.50 (90-day mail order)
$42 (preferred retail)
$47 (standard retail)
$105 (90-day mail order)
45% coinsurance (preferred retail)
50% coinsurance (standard retail)
45% coinsurance (90-day mail order)
30% coinsurance

PriorityMedicare ValueSM

Tier 1
Preferred generic
Tier 2
Generic
Tier 3
Preferred brand
Tier 4
Non-preferred drug
Tier 5
Specialty
$2 (preferred retail)
$7 (standard retail)
$0 (90-day mail order)
$10(preferred retail)
$15 (standard retail)
$0 (90-day mail order)
$42 (preferred retail)
$47 (standard retail)
$105 (90-day mail order)
45% coinsurance (preferred retail)
50% coinsurance (standard retail)
45% consurance (90-day mail order)
31% coinsurance

PriorityMedicare MeritSM

Tier 1
Preferred generic
Tier 2
Generic
Tier 3
Preferred brand
Tier 4
Non-preferred drug
Tier 5
Specialty
$2 (preferred retail)
$7 (standard retail)
$0 (90-day mail order)
$10 (preferred retail)
$15 (standard retail)
$0 (90-day mail order)
After you meet the $75 deductible: $42 (preferred retail)
$47 (standard retail)
$105 (90-day mail order)
After you meet the $75 deductible: 45% coinsurance (preferred retail)
50% coinsurance (standard retail)
45% coinsurance (90-day mail order)
After you meet the $75 deductible: 31% coinsurance

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.

PriorityMedicareSM

Tier 1
Preferred generic
Tier 2
Generic
Tier 3
Preferred brand
Tier 4
Non-preferred drug
Tier 5
Specialty
$1 (preferred retail)
$6 (standard retail)
$0 (90-day mail order)
$8 (preferred retail)
$13 (standard retail)
$0 (90-day mail order)
$38 (preferred retail)
$43 (standard retail)
$95 (90-day mail order)
40% coinsurance (preferred retail)
45% coinsurance (standard retail)
40% coinsurance (90-day mail order)
33% coinsurance

PriorityMedicare SelectSM

Tier 1
Preferred generic
Tier 2
Generic
Tier 3
Preferred brand
Tier 4
Non-preferred drug
Tier 5
Specialty
$1 (preferred retail)
$6 (standard retail)
$0 (90-day mail order)
$7 (preferred retail)
$12 (standard retail)
$0 (90-day mail order)
$37 (preferred retail)
$42 (standard retail)
$92.50 (90-day mail order)
40% coinsurance (preferred retail)
45% coinsurance (standard retail)
40% coinsurance (90-day mail order)
33% coinsurance

Learn rules or requirements on your drugs

Before you fill your prescription, make sure you are aware of any limits or rules. Medicare covers a variety of prescription medications that come with some requirements.