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Drug tiers for 2016


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.

These copayments we show below apply:

  • After you pay 100% of your drug costs up to your prescription deductible, if your plan has one
  • Before you reach $3,310 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 2016*

Plan Tier 1, Preferred generic
Tier 2, Non-preferred
generic
Tier 3, Preferred
brand name
Tier 4, Non-preferred brand name Tier 5, Specialty
PriorityMedicare KeySM  After you meet the $360 deductible: 25% coinsurance
PriorityMedicare IdealSM After you meet the $360 deductible: 25% coinsurance
PriorityMedicare ValueSM After you meet the $75 deductible:
$5 (30-day)
$0(90-day mail order)
 
After you meet the $75 deductible:
$12 (30-day)
$0 (90-day mail order)
After you meet the $75 deductible:
$45 (30-day)
$112.50 (90-day mail order)
After you meet the $75 deductible:
$95 (30-day)
$237.50 (90-day mail order)
After you meet the $75 deductible, you pay
31% of Priority Health's discounted cost (30-day supply only)
PriorityMedicare MeritSM $4 (30-day)
$0 (90-day mail order)
$12 (30-day)
$0 (90-day mail order)
After you meet the $75 deductible**:
$45 (30-day)
$112.50 (90-day mail order)
After you meet the $75 deductible**:
$95 (30-day)
$237.50 (90-day mail order)
After you meet the $75 deductible**:
:31% of Priority Health's discounted cost (30-day supply only)
PriorityMedicareSM $4 (30-day)
$0 (90-day mail order)
$10 (30-day)
$0 (90-day mail order)
$40 (30-day)
$100 (90-day mail order)
$85 (30-day)
$212.50 (90-day mail order)
33% of Priority Health's discounted cost (30-day supply only)
PriorityMedicare SelectSM $4 (30-day)
$0 (90-day mail order)
$9 (30-day)
$0 (90-day mail order)
$40 (30-day)
$100 (90-day mail order)
$85 (30-day)
$212.50 (90-day mail order)
33% of Priority Health's discounted cost (30-day supply only)

*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 $3,310 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.

**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.

Premium assistance

People with low incomes may qualify for extra help paying their Part D prescription coverage. Learn about premium assistance when you review any 2016 Priority Health Medicare Advantage plan.