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 or Amazon (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 $2,100 in out-of-pocket Part D drug costs for the year.
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® Edge (PPO)
Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $200 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 100-day) | $8 | 22% coinsurance | 25% coinsurance | 30% coinsurance |
| Standard retail | $7 | $15 | 25% coinsurance | 30% coinsurance | 30% coinsurance |
| 90-day preferred mail order | $0 | $0 | 22% coinsurance | 25% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Key (HMO-POS)
Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $200 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 100-day) | $8 | 22% coinsurance | 25% coinsurance | 30% coinsurance |
| Standard retail | $7 | $15 | 25% coinsurance | 30% coinsurance | 30% coinsurance |
| 90-day preferred mail order | $0 | $0 | 22% coinsurance | 25% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Vital (PPO)
Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $450 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 100-day) | $10 | $42 | 25% coinsurance | 27% coinsurance |
| Standard retail | $6 | $15 | $47 | 25% coinsurance | 27% coinsurance |
| 90-day preferred mail order | $0 | $0 | $105 | 25% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Thrive (PPO)
Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $250 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 100-day) | $8 | 21% coinsurance | 25% coinsurance | 30% coinsurance |
| Standard retail | $7 | $15 | 21% coinsurance | 25% coinsurance | 30% coinsurance |
| 90-day preferred mail order | $0 | $0 | 21% coinsurance | 25% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Thrive Plus (PPO)
Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $100 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 100-day) | $7 | 22% coinsurance | 35% coinsurance | 31% coinsurance |
| Standard retail | $6 | $12 | 25% coinsurance | 40% coinsurance | 31% coinsurance |
| 90-day preferred mail order | $0 | $0 | 22% coinsurance | 35% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Value (HMO-POS)
Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $100 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 100-day) | $10 | 22% coinsurance | 35% coinsurance | 31% coinsurance |
| Standard retail | $7 | $15 | 25% coinsurance | 40% coinsurance | 31% coinsurance |
| 90-day preferred mail order | $0 | $0 | 22% coinsurance | 35% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Merit (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 100-day) | $10 | 25% coinsurance | 32% coinsurance | 33% coinsurance |
| Standard retail | $7 | $15 | 25% coinsurance | 37% coinsurance | 33% coinsurance |
| 90-day preferred mail order | $0 | $0 | 25% coinsurance | 32% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® (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 100-day) | $8 | 25% coinsurance | 33% coinsurance | 33% coinsurance |
| Standard retail | $6 | $13 | 25% coinsurance | 38% coinsurance | 33% coinsurance |
| 90-day preferred mail order | $0 | $0 | 25% coinsurance | 33% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Vintage (HMO-POS)
Costs shown are what you'll pay after you meet the $615 Part D deductible. The deductible applies to all tiers.| Tier 1 Preferred generic | Tier 2 Generic | Tier 3 Preferred brand | Tier 4 Non-preferred drug | Tier 5 Specialty* | |
| Preferred retail | $0 ($0 for 100-day) | $8 | 25% coinsurance | 35% coinsurance | 25% coinsurance |
| Standard retail | $0 | $15 | 25% coinsurance | 40% coinsurance | 25% coinsurance |
| 90-day preferred mail order | $0 | $0 | 25% coinsurance | 35% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
PriorityMedicare® Smart Savings (HMO-POS)
Costs shown for tiers 3, 4 and 5 are what you'll pay after you meet the $500 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 100-day) | $8 | $42 | 25% coinsurance | 27% coinsurance |
| Standard retail | $6 | $13 | $47 | 25% coinsurance | 27% coinsurance |
| 90-day preferred mail order | $0 | $0 | $105 | 25% coinsurance | N/A |
*Tier 5 Specialty drugs are limited to a 30-day supply per fill.
After you reach $2,100 in drug costs
Once you spend $2,100 out-of-pocket for your Part D drugs during the year, then you enter what's called the "catastrophic stage," and you'll pay $0 for your Part D prescription drugs for the remainder of the plan year.
Think you're getting charged too much for medications?
If you qualify for Extra Help, the Best Available Evidence (BAE) Policy can help us help you pay the right amount for your prescription drug costs.