Prescription drug coverage is included on CHPW Medicare Advantage (MA) Plans 1, 2, 3, 4 and Dual Plan (D-SNP). Our coverage uses a tiered cost-sharing system. You pay either a fixed copay amount or a percentage of the total cost.

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

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.

2023 MA Dual Plan (HMO D-SNP)

Please see the prescription drug coverage page for more information about which specific medications are covered.

Preferred pharmacy options

$0 (for generic drugs) $0 (all other drugs)

2023 MA Plans 1, 2, 3, 4 (HMO)

Preferred pharmacy

30-day supply cost 90-day supply cost Tier 1: $0 copay Tier 1: $0 copay Tier 2: $10 copay Tier 2: $20 copay Tier 3: $42 copay Tier 3: $125 copay Tier 4: 50% coinsurance Tier 4: only available at a 30-day supply Tier 5: 29% coinsurance after deductible for MA Plan 1; 33% coinsurance for MA Plans 2, 3, 4 Tier 5: only available at a 30-day supply

Standard pharmacy

30-day supply cost 90-day supply cost Tier 1: $5 copay Tier 1: $10 copay Tier 2: $15 copay Tier 2: $30 copay Tier 3: $47 copay Tier 3: $140 copay Tier 4: 50% coinsurance Tier 4: only available at a 30-day supply Tier 5: 29% coinsurance after deductible for MA Plan 1; Tier 5: only available at a 30-day supply 33% coinsurance for MA Plans 2, 3, 4

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.

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.