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.
The mail order program may offer lower copays for your medications.
30-day | Retail | 90-Day | Mail Order | |
| Yearly Deductible | $150 T3-T5 | $150 T3-T5 | $150 T3-T5 | $150 T3-T5 |
| Tier 1 (Preferred Generic) | $0 | $0 | $0 | $0 |
| Tier 2 (Generic) | $8 | $16 | $24 | $20 |
| Tier 3 (Preferred Brand) | $47 | $94 | $141 | $118 |
| Tier 4 (Non-Preferred Drug) | 30% of cost | 30% of cost | 30% of cost | 30% of cost |
| Tier 5 (Specialty) | 30% of cost | N/A | N/A | N/A |
Initial Coverage Gap begins at: $4,130
Catastrophic Coverage begins at: $6,550
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 $4,130. 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 $6,550. Medicare sets this amount as well as the rules for what counts toward your OOP costs.
After your yearly out-of-pocket drug costs reach $6,550, you pay the greater of 5% of the drug cost or the copay. The copay is $3.70 for generic drugs, or $9.20 for brand drugs.
