Co-Payment Amounts



Gundersen Health System

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.

Want to save money?

The mail order program may offer lower copays for your medications.

2021 Copay Amounts

 

30-day

Retail
60-Day

90-Day 

Mail Order
90-Day

 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$90 $135 $113 
 Tier 4 (Non-Preferred Drug)  40% of cost 40% of cost 40% of cost 40% of cost
 Tier 5 (Specialty) 30% of cost N/A N/AN/A 

 

Initial Coverage Gap begins at: $4,130
Catastrophic Coverage begins at: $6,550

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 $4,130. 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.

Catastrophic Coverage

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.

This webpage was updated on January 1, 2021.