2022 Lycoming Tioga MA Kit

Get the prescriptions you need and save money $0 preferred generic medications (Tier 1) For all plans during the Initial Coverage stage Fill your prescription at a preferred retail pharmacy or by preferredmail-order, and you’ll have a $0 copay. Low copays for covered diabetic medications (Tier 2) For the Initial Coverage stage of all plans Save money on covered, brand-name, non-insulin diabetic medications that help lower your blood sugar. $10 copay for a 30-day supply filled at a preferred retail pharmacy $20 copay for a 90-day supply filled at a preferred pharmacy Save money with donut hole coverage for insulin medications For all plans during the Coverage Gap stage Your copay is the same in the Initial Coverage and Coverage Gap “donut hole” stages, which may save you hundreds! This applies to covered insulins filled at standard, preferred, or mail-order pharmacies. $35 copay for a 30-day supply filled at retail pharmacies $87.50 copay for a 90-day supply filled at a preferred mail-order pharmacy $96.25 copay for a 90-day supply filled at a preferred retail pharmacy $105 copay for a 90-day supply filled at standard pharmacies Save money on generic drugs in the donut hole (Tier 1 and Tier 2) For HMO Rx members during the Coverage Gap stage With additional coverage through the Coverage Gap “donut hole” stage you will no longer have to pay more for generic drugs on Tier 1 and generic drugs on Tier 2. Generic drugs are listed in lowercase italics in the drug formulary . This benefit does not apply to brand-name drugs. $0 copay for a 30-day supply of Tier 1 generic drugs filled at a preferred retail pharmacy $0 copay for a 90-day supply of Tier 1 generic drugs filled at a preferred pharmacy $10 copay for a 30-day supply of Tier 2 generic drugs filled at a preferred retail pharmacy $20 copay for a 90-day supply of Tier 2 generic drugs filled at a preferred pharmacy upmchealthplan.com/medicare 17 70