2021 PriorityMedicare ValueSM 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 $4,130 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 3-5 are what you'll pay after you meet the $75 Part D deductible. There is no deductible for drugs in tiers 1 or 2.

This plan also offers additional coverage for select insulins while in the coverage gap (deductible does not apply).

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)
50% coinsurance  preferred retail)
50% coinsurance (standard retail)
50% coinsurance (90-day mail order)
31% coinsurance

Drug savings for insulin while in the "coverage gap"

The Value plan offers savings on certain insulin to help you manage diabetes. The Part D deductible is waived for Humalog and Humulin (Tier 2 drugs) or Lantus and Toujeo (Tier 3 drugs) but it does apply to all other drugs in Tiers 3-5.

Your cost for certain insulins while in the "coverage gap"
$10 copay 30-day supply of Humalog, Humalin 100 unit/ml products
(preferred retail pharmacy)
$15 copay 30-day supply of Humalog, Humalin 100 unit/ml products
(standard retail pharmacy)
$35 copay 30-day supply of Lantus and Toujeo

After you reach $4,130 in drug costs

Once you and Priority Health combined spend $4,130 for your drugs during the year, then you enter what's called a "coverage gap." During this gap, you'll pay:

  • 25% 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 $6,550, for the rest of the year you pay the greater of:

  • 5% of the cost OR
  • $3.70 for generic drugs
  • $9.20 for all other drugs