Retail Pharmacy (30 day supply)
Tier 1 (Preferred Generic): $10 copay
Tier 2 (Preferred Brand): $15 copay ($0 most vaccines)
Tier 3 (Non- Preferred): $100 copay
Tier 4 (Specialty): 25% coinsurance
Tier 5 (Select Care Drugs) $0 copay
Home Delivery (Mail Order Pharmacy) (30-day supply)
Tier 1 (Preferred Generic): $5 copay
Tier 2 (Preferred Brand): $7.50 copay ($0 most vaccines)
Tier 3 (Non-Preferred ): $50 copay
Tier 4 (Specialty): 25% coinsurance
Tier 5 (Select Care Drugs) $0 copay
Part D Benefit stages
You will pay the copays and coinsurance amounts listed above until your drug costs reach the catastrophic limit of $7,400. Once you reach $7,400, you will pay the greater of 5% coinsurance or $4.15 copay for generic drugs and $10.35 copay for brand and other multi-source drugs.