2019 PriorityMedicare Select^SM 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).

This plan has no Part D deductible, so you'll only pay these amounts for your drugs.

Tier 1 Preferred generic	Tier 2 Generic	Tier 3 Preferred brand	Tier 4 Non-preferred drug	Tier 5 Specialty
$1 (preferred retail) $6 (standard retail) $0 (90-day mail order)	$7 (preferred retail) $12 (standard retail) $0 (90-day mail order)	$37 (preferred retail) $42 (standard retail) $92.50 (90-day mail order)	40% coinsurance (preferred retail) 45% coinsurance (standard retail) 40% coinsurance (90-day mail order)	33% 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