Drug costs for 2021

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).

PriorityMedicare Edge^SM

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
$2 (preferred retail) $6 (standard retail) $0 (90-day mail order)	$8 (preferred retail) $13 (standard retail) $0 (90-day mail order)	$38 (preferred retail) $43 (standard retail) $95 (90-day mail order)	40% coinsurance  preferred retail) 45% coinsurance (standard retail) 40% coinsurance (90-day mail order)	33% coinsurance

PriorityMedicare Compass^SM

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
$4 (preferred retail) $10 (standard retail) $0 (90-day mail order)	$15 (preferred retail) $20 (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

PriorityMedicare Key^SM 

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
$4 (preferred retail) $10 (standard retail) $0 (90-day mail order)	$15 (preferred retail) $20 (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

PriorityMedicare Vital^SM

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
$1 (preferred retail) $6 (standard retail) $0 (90-day mail order)	$4 (preferred retail) $10 (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)	26% coinsurance

PriorityMedicare Ideal^SM

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
$4 (preferred retail) $9 (standard retail) $0 (90-day mail order)	$13 (preferred retail) $18 (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)	30% coinsurance

PriorityMedicare Value^SM

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

PriorityMedicare Merit^SM

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
$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)	33% coinsurance

PriorityMedicare^SM

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)	$8 (preferred retail) $13 (standard retail) $0 (90-day mail order)	$38 (preferred retail) $43 (standard retail) $95 (90-day mail order)	45% coinsurance  preferred retail) 45% coinsurance (standard retail) 45% coinsurance (90-day mail order)	33% coinsurance

PriorityMedicare Select^SM

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)	45% coinsurance  preferred retail) 50% coinsurance (standard retail) 45% coinsurance (90-day mail order)	33% coinsurance

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