Drug costs for 2019

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).

PriorityMedicareSM

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)
40% coinsurance (preferred retail)
45% coinsurance (standard retail)
40% coinsurance (90-day mail order)
33% coinsurance

PriorityMedicare IdealSM

Costs shown for tiers 1 - 5  are what you'll pay after you meet the $125 Part D deductible.

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)
45% coinsurance (preferred retail)
50% coinsurance (standard retail)
45% coinsurance (90-day mail order)
30% coinsurance

PriorityMedicare KeySM 

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
$5 (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)
30% coinsurance

PriorityMedicare MeritSM

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)
45% coinsurance (preferred retail)
50% coinsurance (standard retail)
45% coinsurance (90-day mail order)
31% coinsurance

PriorityMedicare SelectSM

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

PriorityMedicare ValueSM

Costs shown for tiers 1-5 are what you'll pay after you meet the $75 Part D deductible.

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)
45% coinsurance (preferred retail)
50% coinsurance (standard retail)
45% consurance (90-day mail order)
31% 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