Prescription Drug Coverage Is Included on Plans 1, 2, 3, 4 and Dual Plan (SNP).
Prescription drug coverage has a fixed copay amount or you will pay a percentage of the total cost. Our coverage uses a five-tiered cost sharing system. Tier 1 represents the lowest cost generic drugs and Tier 5 represents the highest cost brand drugs and potent drugs that may require monitoring.
COVID-19 Vaccines: The Pfizer BioNTech, Moderna, and Johnson & Johnson COVID-19 vaccines are covered as part of the medication benefit on Plans 1, 2, 3, 4, and Dual Plan (SNP) at any location they are offered.
➔ Learn more about COVID-19 vaccines, eligibility and locations
Cost-Sharing Tier 1: Preferred Generic
Tier 1 is the lowest tier. Low cost preferred generic drugs are a part of this tier.
Cost-Sharing Tier 2: Generic
Tier 2 includes preferred generic drugs.
Cost-Sharing Tier 3: Preferred Brand
Tier 3 includes preferred brand drugs and non-preferred generic drugs.
Cost-Sharing Tier 4: Non-Preferred Drug
Tier 4 includes non-preferred brand drugs and non-preferred generic drugs.
Cost-Sharing Tier 5: Specialty Tier
Tier 5 is the highest tier. It contains high cost and brand name drugs.
2021 Pharmacy Tier Pricing
We can help you decide which tier coverage you need based on the current medications you take. Discuss your prescription drug options with your primary care provider or your pharmacist. For the lowest copay amounts, use the preferred pharmacy.
Preferred pharmacy options- Tier 1: $0 copay
- Tier 2: $10 copay
- Tier 3: $42 copay
- Tier 4: 50% coinsurance
- Tier 5: 29% coinsurance after deductible for MA Plan 1 (HMO) 016, 33% coinsurance for MA Plan 2 (HMO) 010, MA Plan 3 (HMO) 008, and MA Plan 4 (HMO) 009
- Tier 1: $5 copay
- Tier 2: $15 copay
- Tier 3: $47 copay
- Tier 4: 50% coinsurance
- Tier 5: 29% coinsurance after deductible for MA Plan 1 (HMO) 016, 33% coinsurance for MA Plan 2 (HMO) 010, MA Plan 3 (HMO) 008, and MA Plan 4 (HMO) 009
Prescription Benefits for MA Dual Plan (HMO SNP)
Please read the prescription drug coverage page for more information about which specific medications are covered.
2021 Preferred pharmacy options- $0, $1.30, $4.00 or 15% (for generic drugs)
- $0, $3.70, $9.20 or 15% (all other drugs)
Get a Larger Supply of Select Medications
Our members can get a 90-day supply of select medications used to treat chronic conditions (known as maintenance medications) such as high blood pressure, diabetes, and depression. Larger supplies of prescriptions are available exclusively through Community Health Center pharmacies and select network pharmacies (preferred pharmacies). Check Prescription Drug Coverage page to learn how to get started with home delivery.
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.
