2022 Lycoming Tioga MA Kit

Prescription Drug Costs There are four stages of the Part D benefit. The amount you pay for your drugs may change as you move through these different stages. Your costs can also depend on the pharmacy you use and the tier of your drug. Part D Deductible stage Our plans do not have a deductible for Part D prescription drugs. This stage does not apply to our plans. Initial Coverage Stage You pay the copays below until your total yearly costs reach $4,430 . The total yearly drug costs are the drug costs paid by both you and your Part D plan. Most people will stay in this stage for the entire year. 90-Day Supply 30-Day Supply Mail-Order Retail Retail Standard Pharmacy Preferred Pharmacy Standard Pharmacy Preferred Pharmacy Standard Pharmacy Preferred Pharmacy Tier $30 $0 $30 $0 $15 $0 Tier 1 Preferred Generic $40 $20 $40 $20 $20 $10 Tier 2 Generic $141 $117.50 $141 $129.50 $47 $47 Tier 3 Preferred Brand $300 $300 $300 $300 $100 $100 Tier 4 Non- Preferred 33% (30-day supply only) 33% (30-day supply only) Not offered Not offered 33% 33% Tier 5 Specialty $105 $87.50 $105 $96.25 $35 $35 Covered Insulins If you reside in a long-term care facility, you pay the same copay as you would at a preferred retail pharmacy for a 31-day supply. upmchealthplan.com/medicare 15 68