Medicare Advantage Members

copay amounts – Gundersen health system Minnesota

The copay is the amount you pay when you get a prescription filled. A copay may be a flat dollar amount or a percentage of the total cost of a drug.

Drug Maintenance

Prescriptions are often sold in 30-day supplies. However, you can buy up to a 90-day supply on medications in tiers 1 through 4. Each 30-day supply will take one copay at a retail pharmacy. A 90-day supply equals three copays.

If you live in a long-term care facility, your copay is the same as in a retail pharmacy.

You can get prescriptions from an out-of-network pharmacy, but you may pay more.

2023 Copay Amounts

Part D vaccines are covered at no cost to you.  You won’t pay more than $35 for a one-month supply of covered insulin, no matter what cost-sharing tier it’s on.

Retail 30-dayRetail 60-DayRetail 90-Day Mail Order
 Tier 1 (Preferred Generic) $2 $4 $6 $5
 Tier 2 (Generic) $15$30$45$38 
 Tier 3 (Preferred Brand)$45$90$135$113 
 Tier 4 (Non-Preferred Drug)   $100 $200 $300 $300
 Tier 5 (Specialty) 33% of costN/A N/A N/A
Tier 6 (Vaccines)$0N/AN/AN/A

Initial Coverage Gap begins at: $4,660 | Catastrophic Coverage begins at: $7,400

2022 Copay Amounts

90-DayMail Order
Yearly Deductible$0$0$0$0
Tier 1 (Preferred Generic)$3$6$9$7
Tier 2 (Generic)$15$30$45$38
Tier 3 (Preferred Brand)$45
$35 for select insulins
$70 for select insulins
$105 for select insulins
$87 for select insulins
Tier 4 (Non-preferred Drug)40% of cost40% of cost40% of cost40% of cost
Tier 5 (Specialty)30% of costN/AN/AN/A
Tier 6 (Vaccines)$0$0$0$0

Initial Coverage Gap begins at: $4,430 | Catastrophic Coverage begins at: $7,050

Coverage Gap

Most Medicare drug plans have a coverage gap every year.

You enter the coverage gap once the total amount spent on Part D drugs reaches $4,430. This includes your payments plus plan payments. During this stage, you pay 25% of the price for drugs, plus a portion of the dispensing fee. You stay in this stage until your year-to-date out-of-pocket (OOP) costs (your payments) reach a total of $7,050. Medicare sets this amount as well as the rules for what counts toward your OOP costs.

Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $7,050, you pay the greater of 5% of the drug cost or the copay. The copay is $3.95 for generic drugs or $9.85 for brand drugs.

Senior Savings Program

Select insulins (insulins that are listed on our Drug Formulary) are available at a $35 copay per month at retail pharmacies and $87 for 3 months through our mail-order pharmacy.  Members will only pay this amount whether they are in the deductible, initial, or gap coverage phases.

Medicare Advantage Drug Information

Looking for information on your drug plan? Find answers to your questions and view the drug list.