South Texas Prescription Drug Benefits2023-09-22T12:14:28-04:00
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South Texas Prescription Drug Benefit Overview

2024 – Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy and Zapata County Drug Benefits

Standard Retail Cost-Sharing — 30-day Supply

  Plus Plan BEYOND Plan GIVEBACK Plan EXTRA HELP Plan Dual Plan
Prescription Drug Deductible No Deductible No Deductible No Deductible No Deductible* No Deductible
Tier 1: Preferred Generic $0 $0 $0 $0 $0
Tier 2: Generic $12 $12 $12 $0 $0
Tier 3: Preferred Brand $35 $42 $42 $0 $0
Tier 4: Non Preferred Drugs $100 $100 $100 $0 $0
Tier 5: Specialty Drugs 33% 33% 33% $0 $0
Tier 6: Specialty Drugs $0 $0 $0 $0 $0
Gap Coverage Tiers 1, 2 & 6 Tiers 1, 2 & 6 Tiers 1, 2 & 6 N/A N/A

*You must be enrolled in Medicare’s Extra Help Program to receive $0 prescriptions and no deductible.

Prescriptions are also available in a 100-day supply at two copays, and through mail order.

South Texas Prescription Drug Benefit Overview

2024 – Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy and Zapata County Drug Benefits

Standard Retail Cost-Sharing — 30-day Supply

Prescription Drug Deductible
No Deductible

Tier 1: Preferred Generic
$0

Tier 2: Generic
$12

Tier 3: Preferred Brand
$35

Tier 4: Non Preferred Drugs
$100

Tier 5: Specialty Drugs
33%

Tier 6: Specialty Drugs
$0

Gap Coverage
Tiers 1, 2 & 6

Prescription Drug Deductible
No Deductible

Tier 1: Preferred Generic
$0

Tier 2: Generic
$12

Tier 3: Preferred Brand
$42

Tier 4: Non Preferred Drugs
$100

Tier 5: Specialty Drugs
33%

Tier 6: Specialty Drugs
$0

Gap Coverage
Tiers 1, 2 & 6

Prescription Drug Deductible
No Deductible

Tier 1: Preferred Generic
$0

Tier 2: Generic
$12

Tier 3: Preferred Brand
$42

Tier 4: Non Preferred Drugs
$100

Tier 5: Specialty Drugs
33%

Tier 6: Specialty Drugs
$0

Gap Coverage
Tiers 1, 2 & 6

Prescription Drug Deductible
No Deductible*

Tier 1: Preferred Generic
$0

Tier 2: Generic
$0

Tier 3: Preferred Brand
$0

Tier 4: Non Preferred Drugs
$0

Tier 5: Specialty Drugs
$0

Tier 6: Specialty Drugs
$0

Gap Coverage
N/A

Prescription Drug Deductible
No Deductible

Tier 1: Preferred Generic
$0

Tier 2: Generic
$0

Tier 3: Preferred Brand
$0

Tier 4: Non Preferred Drugs
$0

Tier 5: Specialty Drugs
$0

Tier 6: Specialty Drugs
$0

Gap Coverage
N/A

*You must be enrolled in Medicare’s Extra Help Program to receive $0 prescriptions and no deductible.

Prescriptions are also available in a 100-day supply at two copays, and through mail order.

2023 – Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy and Zapata County Drug Benefits

Standard Retail Cost-Sharing — 30-day Supply

Prominence Plus Plan Prominence Dual Plan
Prescription Drug Deductible No Deductible No Deductible
Phase 1: Initial Coverage
Tier 1 (Preferred Generic)		 You pay $0 You pay $0
Tier 2 (Generic) You pay $12 You pay $0
Tier 3 (Preferred Brand) You pay $35 You pay $0
Tier 4 (Non-Preferred Drugs) You pay $100 You pay $0
Tier 5 (Specialty Drugs) You pay 33% You pay $0
Tier 6 (Selected Drugs) You pay $0 You pay $0
Phase 2: Coverage Gap
Tier 1, 2 and 6
 Drugs are covered in the gap You pay $0
Tiers 3, 4 and 5 N/A You pay $0

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Last update 9/9/2022