Prescription Drug Benefits

The VIP Premier (HMO) Medicare plan includes an in-network prescription drug benefit which covers drugs that are prescribed by network doctors and filled by our nationwide network of pharmacies or the network home delivery service.

The standard prescription plan offers a basic Medicare Part D plan. City of New York retirees who do not receive prescription drug coverage through their Union Welfare Fund must purchase a prescription drug rider, which provides additional prescription drug benefits with no annual limit.

Drug Type Drug Benefit: Standard Drug Benefit: With Rider
Tier 1 (Preferred generic drugs) $10 copay per 30-day supply $10 copay per 30-day supply
Tier 2 (Preferred brand drugs) $20 copay per 30-day supply $15 copay per 30-day supply
Tier 3 (Non preferred generic and brand drugs) 50% coinsurance per 30-day supply 50% coinsurance per 30-day supply
Tier 4 (Specialty drugs) 25% coinsurance per 30-day supply 25% coinsurance per 30-day supply

Home delivery (preferred drugs) Tier 1: $5 copay per 30-day supply

Tier 2: $10 copay per 30-day supply Tier 2: $7.50 copay per 30-day supply

Tier 3: 50% coinsurance per 30-day supply

Tier 4: Not applicable
Benefit limits The member pays copays and coinsurance as listed above for drug costs between $0 and $2,960. After reaching $2,960, the member is covered only for generic drugs, until the member qualifies for catastrophic coverage. The member also receives a discount on brand drugs. The member pays copays and coinsurance as listed above for drug costs between $0 and $2,960. After reaching $2,960, the member is covered for generic and brand drugs, until the member qualifies for catastrophic coverage.
Catastrophic When the member reaches $4,700 in out-of-pocket costs for Tiers 1-4 during the calendar year, the member will pay a $2.65 copay per prescription for Tier 1 drugs; and a $6.60 copay or 5% coinsurance (whichever is greater) per prescription for Tier 2-4 drugs.

See the Drug Formulary for the listing of preferred, non-preferred and specialty covered drugs.