2019 PriorityMedicare MeritSM drug costs

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 and at a standard pharmacy, and for a 90-day supply through mail order (with free shipping). Costs may vary when your plan is provided by an employer.

Your drug copays/coinsurance

This is what you'll pay until you reach $3,820 in total drug costs for the year (the combined total of what you have paid plus what Priority Health has paid for your prescriptions).

Costs shown for Tiers 3, 4 and 5 are what you'll pay after you meet the $75 Part D deductible. There is no deductible for drugs in tiers 1 or 2.

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% coinsurance (90-day mail order)
31% coinsurance

After you reach $3,820 in drug costs

Once you and Priority Health combined spend $3,820 for your drugs during the year, then you enter what's called a "coverage gap." During this gap, you'll pay:

  • 37% of the cost of your generic drugs
  • 25% of the cost of your brand drugs, plus dispensing fee

Then, once your out-of-pocket Part D drug costs reach $5,100, for the rest of the year you pay the greater of:

  • 5% of the cost OR
  • $3.40 for generic drugs
  • $8.50 for all other drugs