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Drug tiers for 2015


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 your first $75 in drug costs (your prescription deductible)
  • Before you reach $2,960 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 tiers for 2015**

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 IdealSM After you meet the $320 deductible: 25% coinsurance for all prescriptions
PriorityMedicare ValueSM After you meet the $75 deductible:
$5 (30-day)
$12.50 (90-day mail order)
 
After you meet the $75 deductible:
$12 (30-day)
$30 (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)
$10 (90-day mail order)
$12 (30-day)
$30 (90-day mail order)
$45 (30-day)
$112.50 (90-day mail order)
$95 (30-day)
$237.50 (90-day mail order)
33% of Priority Health's discounted cost (30-day supply only)
PriorityMedicareSM $4 (30-day)
$10 (90-day mail order)
$10 (30-day)
$25 (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)
$10 (90-day mail order)
$9 (30-day)
$22.50 (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 $2,960 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.

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 2015 Priority Health Medicare Advantage plan.