What to do when your drug is covered

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.