Drug costs for 2023

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
  • A 30-day supply at a standard pharmacy, and 
  • A 90-day supply through our preferred mail order pharmacy, Express Scripts (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 $4,660 in total drug costs for the year (the combined total of what you have paid plus what Priority Health has paid for your prescriptions).

Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible (if your plan has a deductible). Call Customer Service for more information.

Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible (if your plan has a deductible).

PriorityMedicare EdgeSM (PPO)

This plan has no Part D deductible, so you'll 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*
Preferred retail $2 ($0 for 90-day) $8 $38 40% coinsurance 33% coinsurance
Standard retail $7 $15 $47 45% coinsurance 33% coinsurance
90-day preferred
mail order		 $0 $0 $95 40% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicare CompassSM (PPO)

This plan has no Part D deductible, so you'll 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*
Preferred retail $4 ($0 for 90-day) $15 $42 45% coinsurance 33% coinsurance
Standard retail $11 $20 $47 50% coinsurance 33% coinsurance
90-day preferred
mail order		 $0 $0 $105 45% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicare KeySM (HMO-POS)

This plan has no Part D deductible, so you'll 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*
Preferred retail  $4 ($0 for 90-day) $15 $42 45% coinsurance 33% coinsurance
Standard retail $10 $20 $47 50% coinsurance 33% coinsurance
90-day preferred
mail order		 $0 $0 $105 45% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicare VitalSM (PPO)

Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $350 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*
Preferred retail $1 ($0 for 90-day) $10 $42 45% coinsurance 26% coinsurance
Standard retail $6 $15 $47 50% coinsurance 26% coinsurance
90-day preferred
mail order		 $0 $0 $105 45% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicare ONESM (HMO-POS)

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*
Preferred retail $0 ($0 for 90-day) $10 $42 45% coinsurance 33% coinsurance
Standard retail $6 $20 $47 50% coinsurance 33% coinsurance
90-day preferred
mail order		 $0 $0 $105 45% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill

PriorityMedicare + KrogerSM (PPO)

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*
Preferred retail $3 ($0 for 90-day) $10 $42 45% coinsurance 33% coinsurance
Standard retail $11 $18 $47 50% coinsurance 33% coinsurance
90-day preferred
mail order		 $0 $0 $105 45% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicare IdealSM (PPO)

Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $125 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*
Preferred retail $4 ($0 for 90-day) $13 $42 50% coinsurance 30% coinsurance
Standard retail $9 $18 $47 50% coinsurance 30% coinsurance
90-day preferred
mail order		 $0 $0 $105 50% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicare ValueSM(HMO-POS)

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*
Preferred retail $2 ($0 for 90-day) $10 $42 50% coinsurance 31% coinsurance
Standard retail $7 $15 $47 50% coinsurance 31% coinsurance
90-day preferred
mail order		 $0 $0 $105 50% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicare MeritSM(PPO)

This plan has no Part D deductible, so you'll 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*
Preferred retail $2 ($0 for 90-day) $10 $42 50% coinsurance 33% coinsurance
Standard retail $7 $15 $47 50% coinsurance 33% coinsurance
90-day preferred
mail order		 $0 $0 $105 50% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

PriorityMedicareSM(HMO-POS)

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*
Preferred retail $1 ($0 for 90-day) $8 $38 45% coinsurance 33% coinsurance
Standard retail $6 $13 $43 45% coinsurance 33% coinsurance
90-day preferred
mail order 		$0 $0 $95 45% coinsurance N/A

PriorityMedicare SelectSM(PPO)

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*
Preferred retail $1 ($0 for 90-day) $7 $37 45% coinsurance 33% coinsurance
Standard retail $6 $12 $42 50% coinsurance 33% coinsurance
90-day preferred
mail order		 $0 $0 $92.50 45% coinsurance N/A

*Tier 5 Specialty drugs are limited to a 30-day supply per fill.

After you reach $4,660 in drug costs

Once you and Priority Health combined spend $4,660 for your drugs during the year, then you enter what's called the "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 $7,400, for the rest of the year you pay the greater of:

  • 5% of the cost OR
  • $4.15 for generic drugs
  • $10.35 for all other drugs