PriorityMedicare Rx Plan Details

When you only need prescription coverage

As a Medicare Part D prescription drug plan, PriorityMedicare Rx^SM offers savings on your prescriptions now and protects you from rising prescription costs in the future. It's available throughout Michigan.

Note: Priority Health is contracted with the federal government to provide Medicare coverage, including Medicare Part D.

PriorityMedicare Rx
Monthly premium	$38.401
Deductible	$0
Initial Coverage: You pay the following until YOUR yearly drug costs2 reach [$2,700]:
Here's what you pay at retail pharmacies for:
Generic	In-network $7 copay for a one-month (31-day) supply of drugs $21 copay for a three-month (90-day) supply of drugs Out-of-network $7 copay for a one-month (31-day) supply of drugs
Preferred brand	In-network $42 copay for a one-month (31-day) supply of drugs $126 copay for a three-month (90-day) supply of drugs Out-of-network $42 copay for a one-month (31-day) supply of drugs
Non-preferred brand	In-network $65 copay for a one-month (31-day) supply of drugs $195 copay for a three-month (90-day) supply of drugs Out-of-network $65 copay for a one-month (31-day) supply of drugs
Specialty (usually injectable; must be ordered from a specialty pharmacy)	In-network 33% coinsurance for a one-month (31-day) supply of drugs Out-of-network 33% coinsurance for a one-month (31-day) supply of drugs
Here's what you pay at long-term care pharmacies for:
Generic	$7 copay for a one-month (31-day) supply of drugs
Preferred brand	$42 copay for a one-month (31-day) supply of drugs
Non-preferred brand	$65 copay for a one-month (31-day) supply of drugs
Specialty (usually injectable; must be ordered from a specialty pharmacy)	In-network 33% coinsurance for a one-month (31-day) supply of drugs Out-of-network 33% coinsurance for a one-month (31-day) supply of drugs
Here's what you pay using the PriorityMedicare mail service pharmacy for:
Generic	$17.50 copay for a three-month (90-day) supply of drugs
Preferred brand	$105 copay for a three-month (90-day) supply of drugs
Non-preferred brand-name	$162.50 copay for a three-month (90-day) supply of drugs
Coverage Gap:
After your total yearly drug costs2 reach $2,700, you pay 100% until your yearly out-of-pocket drug costs3 reach $4,350.
Catastrophic Coverage after you reach $4,350 in out-of-pocket DRUG costs3
Generics (and a few brand-name drugs)	In-network $2.40 copay OR 5% of discounted cost4 (whichever is greater) Out-of-network $2.40 copay OR 5% of discounted cost4 (whichever is greater)
Most brand name drugs	In-network $6.00 copay OR 5% of discounted cost4 (whichever is greater) Out-of-network $6.00 copay OR 5% of discounted cost4 (whichever is greater)

¹You must continue to pay your Medicare Part A and/or B premium if not otherwise paid for under Medicaid or by another third party. You may qualify for help with your premium. Find out here.
² Total prescription costs include the copays you pay AND the costs the plan pays in 2009.
³ Your out-of-pocket costs include what you pay for prescription drugs (copays and/or the percentage of the cost you pay) in 2009.
⁴ Priority Health's discount averages 16% on most brand-name drugs, 58% or more on generics.

Additional information

2009 PriorityMedicare Rx Summary of Benefits (300KB PDF) 
2009 PriorityMedicare Rx Evidence of Coverage (506KB PDF)
2009 Approved Drug List (184KB PDF)
2009 Pending Changes to Approved Drug List
2009 Pharmacy Directory (465KB PDF)
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