2022 Lycoming Tioga MA Kit

Prescription drug costs Below are the copays for our Part D prescription drug coverage. We’ve added even more medications to our $0 preferred generic drug list. These prescriptions have a $0 copay when filled at a preferred retail or mail-order pharmacy. You can see a list of all $0 preferred generic medications, including diabetic generic medications, at upmchp.us/prescription-coverage. These copays apply only during the initial coverage stage. 90-day supply 30-day supply Mail Order Retail Retail Standard Pharmacy Preferred Pharmacy Standard Pharmacy Preferred Pharmacy Standard Pharmacy Preferred Pharmacy Tier $30 copay $0 copay $30 copay $0 copay $15 copay $0 copay Tier 1 Preferred generic $40 copay $20 copay $40 copay $20 copay $20 copay $10 copay Tier 2 Generic $141 copay $117.50 copay $141 copay $129.50 copay $47 copay $47 copay Tier 3 Preferred brand $300 copay $300 copay $300 copay $300 copay $100 copay $100 copay Tier 4 Nonpreferred 33% coinsurance 33% coinsurance (30-day supply only) Not offered Not offered 33% coinsurance 33% coinsurance Tier 5 Specialty (30-day supply only) Low copays for covered diabetic medications (Tier 2) You can save money on covered, brand-name, non-insulin diabetic medications that help lower blood sugar. You pay a $10 copay for a 30-day supply and a $20 copay for a 90-day supply at preferred pharmacies. 6 Donut hole coverage for insulin medications Your copays for covered insulin medications are the same in the initial coverage and coverage gap "donut hole" stages. You can save hundreds of dollars each year! 6 $35 for a 30-day supply at retail pharmacies $87.50 for a 90-day supply at a preferred mail-order pharmacy $96.25 for a 90-day supply at a preferred retail pharmacy $105 for a 90-day supply at standard pharmacies