Pharmacy Benefits


Part D Prescription Drug Coverage

 

30-day

Retail
60-Day

90-Day 

Mail Order
90-Day

 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/AN/A 

 

Initial Coverage Gap begins at: $4,130

Catastrophic Coverage begins at: $6,550

View Drug Prices and Pharmacy Network

This webpage was updated on October 19, 2020.