Prescription Drugs - Community Health Plan of Washington - Medicare Advantage

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.

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