Prescription Drug Coverage Is Included on Plans 008, 009, 010, 016, 014
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.
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.
2019 Pharmacy Tier Pricing
For preferred pharmacy options, the tier pricing is as follows:
- Tier 1: $0 copay
- Tier 2: $10 copay
- Tier 3: $42 copay
- Tier 4: 50% coinsurance
- Tier 5: 30% coinsurance
For standard pharmacy options, the tier pricing is as follows:
- Tier 1: $5 copay
- Tier 2: $15 copay
- Tier 3: $47 copay
- Tier 4: 50% coinsurance
- Tier 5: 30% coinsurance
2020 Pharmacy Tier Pricing
For preferred pharmacy options, the tier pricing is as follows:
- Tier 1: $0 copay
- Tier 2: $10 copay
- Tier 3: $42 copay
- Tier 4: 50% coinsurance
- Tier 5: 33% coinsurance
For standard pharmacy options, the tier pricing is as follows:
- Tier 1: $5 copay
- Tier 2: $15 copay
- Tier 3: $47 copay
- Tier 4: 50% coinsurance
- Tier 5: 33% coinsurance
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.
Prescription Benefits for SNP plan 014
2019 Preferred pharmacy options
$0 or $1.25 or $3.40 (for generic drugs)
$0 or $3.70 or $8.50 (all other drugs)
2020 Preferred pharmacy options
$0 – $3.60 (for generic drugs)
$0 or $8.50 (all other drugs)
Please read the prescription drug coverage page for more information about which specific medications are covered.
