Prescription drug coverage is included on CHPW Dual Complete and Dual Select Plans (HMO D-SNP) for 2026. Our coverage uses a tiered cost-sharing system. You pay either a fixed copay amount or a percentage of the total cost. The amount will vary based on your income level.
2026 Prescription Cost-Sharing Tiers
2026 Dual Complete (HMO D-SNP) Prescription Cost-Sharing Tiers
| Tier | Dual Complete (One month supply) | |
|---|---|---|
| Coinsurance | ||
| Tier 1 (Pref. Generic) | 25% | |
| Tier 2 (Non Pref. Generic) | 25% | |
| Tier 3 (Pref. Brand) | 25% | |
| Tier 4 (Non Pref. Brand) | 45% | |
| Tier 5 (Specialty) | 25% | |
| Tier 6 (Select Care Drugs) | $0 | |
2026 Dual Select (HMO D-SNP) Prescription Cost-Sharing Tiers
| Tier | Dual Select (One month supply) | |
|---|---|---|
| Coinsurance | ||
| Tier 1 (Pref. Generic) | 25% | |
| Tier 2 (Non Pref. Generic) | 25% | |
| Tier 3 (Pref. Brand) | 25% | |
| Tier 4 (Non Pref. Brand) | 50% | |
| Tier 5 (Specialty) | 25% | |
| Tier 6 (Select Care Drugs) | $0 | |
2026 Insulin Costs Tiers (Dual Complete and Dual Select (HMO D-SNP)
| Tier | Insulin Costs |
|---|---|
| Tier 1 | N/A |
| Tier 2 | N/A |
| Tier 3 | Lesser of $35 or 25% |
| Tier 4 | Lesser of $35 or 25% |
| Tier 5 | N/A |
| Tier 6 | N/A |
2025 Prescription Cost-Sharing Tiers
Tier 1 represents the lowest cost generic drugs and Tier 5 represents the highest cost brand drugs and potent drugs that may require monitoring.
- Tier 1: Preferred Generic – includes lowest cost preferred generic drugs
- Tier 2: Generic – includes preferred generic drugs
- Tier 3: Preferred Brand – includes preferred brand drugs and non-preferred generic drugs
- Tier 4: Non-Preferred – includes non-preferred brand drugs and non-preferred generic drugs
- Tier 5: Specialty Tier – includes high cost and brand name drugs
Prescription Pricing (2025)
We can help you decide which tier of coverage you need based on the current medications you take. If you’re a current member, please call 1-800-942-0247 (TTY: 711). For prospective members, please call 1-800-944-1247 (TTY: 711). We’re here for you seven days a week, 8:00 a.m. to 8:00 p.m.
To discuss which prescription medications you need, contact your primary care provider or pharmacist.
And keep in mind—for the lowest copays, use a preferred pharmacy.
2025 MA Plan prescription pricing
| Preferred pharmacy options for
Dual Complete (HMO D-SNP) |
|
| Preferred pharmacy options for
Dual Select (HMO D-SNP) |
|
Medicare Advantage Plans 2, 4 (HMO)
| Preferred pharmacy |
|
| Standard pharmacy |
|
Get the most of your prescription benefits
Additional highlights include:
- 90-day supply of select medications used to treat chronic conditions (e.g., high blood pressure, diabetes, depression)
- Free home delivery
- Searchable and printable prescription drug formularies (lists of covered drugs)
- Coverage accepted at more 1,000 Washington State pharmacies and more than 50,000 pharmacies nationwide
Eligibility criteria may apply. ➔ Learn more about Prescription Drug Coverage.
Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan is a payment option in the prescription drug law that works with your current drug coverage to help you manage your out of-pocket Medicare Part D drugs costs by spreading the cost monthly across the calendar year (January-December).
Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage* (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary.
If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.
For more information, please see the Medicare Prescription Payment Plan Facts Sheet.
How to enroll
To enroll in the Medicare Prescription Payment Plan, or MPPP, you will need to fill out the enrollment form. You can do this online or by phone.
Online
Complete the online form at: https://www.express-scripts.com/mppp
Phone
Call Express Scripts at 1-866-845-1803 (TTY: 1-800-716-3231) 24 hours a day, 7 days a week to submit your request via telephone.
We’re here to help.
To ask questions, request print copies of materials, and more, contact Customer Service at 1-800-942-0247 (TTY: 711), 8:00 a.m. to 8:00 p.m., 7 days a week.
Did you know that certain prescription medicines are available as a 90-day supply? Medicine that you take on a long-term basis to manage your health is called a “maintenance drug.” A 90-day supply makes it easier to keep taking the medicine you need to feel your best. You may also be eligible to receive your long-term medications through free home delivery.
