Drug Costs Under PriorityMedicareRx Plan

The PriorityMedicareRX^SM plan will pay part of the costs for your covered drugs. You will pay part, too; your part is called a "copayment." Plan benefits may vary when provided by an employer. People on limited incomes may qualify for extra help; find out more.

Your Initial Copayments
Drug Tier	31-Day Supply Retail Network Pharmacies	90-Day Supply Select Retail Network Pharmacies	90-Day Supply Mail Service Pharmacies
Loratadine, Loratadine-D & Prilosec OTC®	$0.00	$0.00	$0.00
Tier 1 (generics)	$10.00	$30.00	$20.00
Tier 2 (preferred brand names)	$39.00	$117.00	$78.00
Tier 3 (non-preferred)	$67.00	$201.00	$134.00

The amount you will pay depends on:

• Drug tier: Find out what tier your drug is in by looking it up in a PriorityMedicare Formulary (list of approved drugs).
• Type of pharmacy: Whether you fill your prescription at a retail pharmacy in our network, a select retail network pharmacy, or a network mail service pharmacy. The Pharmacy Directory will tell you which pharmacies are in-network, which are selected to dispense extended-day supplies, and more about our mail service pharmacies.
• How much you've already paid during the plan year: Whether the total costs of your drugs or your out-of-pocket costs have reached certain limits (see Copayment Limits, below).
• Priority Health's drug discount: When you must pay 100% of the cost for any drug at a network pharmacy, that price includes a discount negotiated by Priority Health. This discount averages 16% on brand names to 58% or more on generic drugs.
• Other factors: Plan benefits vary when offered through an employer. Also, if you qualify for extra help with your drug costs, the costs for your drugs may be different than those described below. More about extra help for people with limited incomes or resources.

Copayment Limits:
After your total annual drug costs (the amount you paid, plus the amount the plan has paid) reach $2,400.00, there is a gap in your coverage. This means you have to pay the full amount (less Priority Health's discount - see above) for your drugs. You pay the full amount until you have paid $3,850.00 out of pocket during the year. 

After your personal annual out-of-pocket drug costs reach $3,850.00, you will pay the copayments in the chart below for the rest of the year.

Copayments After $3,850 Annual Limit is Reached
Drug Type	31-Day Supply Retail Network Pharmacies	90-Day Supply Select Retail Network Pharmacies	90-Day Supply Mail-Service Pharmacies
Generics, and a few brand names	$2.15 OR 5% coinsurance whichever is greater	$2.15 OR 5% coinsurance whichever is greater	$2.15 OR 5% coinsurance whichever is greater
Most brand names	$5.35 OR 5% coinsurance whichever is greater	$5.35 OR 5% coinsurance whichever is greater	$5.35 OR 5% coinsurance whichever is greater