Western PA/Susquehanna Member Guide

21 Lower copays for diabetic medications Donut hole coverage for insulin medications Save money when you fill covered diabetic insulin medications in the Part D Coverage Gap, otherwise known as the “donut hole.” You pay the same copay in the Coverage Gap Stage as you do in the Initial Coverage Stage. That means you could save hundreds of dollars each year when filling your insulin medications. This applies to covered insulins filled at standard, preferred, or mail-order pharmacies! • $35 copay for 30-day supply • $87.50 copay for 90-day supply Lower copays for covered brand-name diabetic medications You can save money on covered brand-name diabetic medications that help lower your blood sugar. Copays for these medications are as low as $10 when you fill a 30-day supply at a preferred pharmacy or $20 when you fill a 90-day supply at preferred or mail-order pharmacies. Lower copays for non-insulin brand-name diabetic medications apply only to the Initial Coverage Stage and do not apply to the HMO Premier Rx plan. Members who receive Low Income Subsidy (Extra Help paying for Part D prescriptions) will not have reduced copays or reduced insulin costs. These benefits do not apply to the HMO No Rx plan and some employer group plans. See your plan formulary for more information. HMO Rx members have additional donut hole coverage for generic Tier 1 and 2 drugs Members on the HMO Rx plan now have additional coverage for generic Tier 1 and 2 drugs through the Medicare Part D Coverage Gap, otherwise known as the “donut hole.” You pay the same copays in the Part D Initial Coverage and Coverage Gap donut hole stages. That means you will not pay more in the donut hole. When you fill these medications at a preferred pharmacy, you will pay: • $0 copay for a 30-day supply of Tier 1 generic drugs. • $0 copay for a 90-day supply of Tier 1 generic drugs. • $10 copay for a 30-day supply of Tier 2 generic drugs. • $20 copay for a 90-day supply of Tier 2 generic drugs. See our covered drug list for more information at upmchp.us/prescription-coverage.