2018 Prescription Drug Benefits2018-11-07T14:16:41+00:00

2018 Prescription Drug Benefits

Formulary and Cost-Sharing Tiers

The Prominence Plus and Enhanced plans include prescription drug coverage. They have six cost-sharing tiers for prescription drugs. To find out which cost-sharing tier your drug is in, refer to your plan’s formulary.

2018 Formulary
2018 Formulary (Spanish)

Tier 1 – Preferred Generic
Tier 2 – Generic
Tier 3 – Preferred Brand
Tier 4 – Non-Preferred Drugs
Tier 5 – Specialty Tier
Tier 6 – Selected Drugs

Coverage Stages — How Much Do You Pay?

Determine how much the drug will cost based on your coverage stage.

Stage 1: Initial Coverage Stage

The cost of your drugs is split between you and the plan. You stay in this stage until your payments for the year plus the plan’s payments total $3,820.

Stage 2: Coverage Gap Stage/Donut Hole

You pay 25 percent of the plan’s cost for covered brand name drugs and 37 percent of the plan’s cost for covered generic drugs until your costs total $5,100, unless you are already getting Medicare Extra Help.1

Stage 3: Catastrophic Coverage Stage

Once you have paid enough for your drugs to move into this last payment stage, the plan will pay most of the cost of your drugs for the rest of the year.2

1 The Prominence Plus Plan provides Tier 6 coverage during the Coverage Gap/Donut Hole. Contact the plan for more information.

2 You pay the greater of 5 percent or $3.40 for generic or preferred multi-source drugs and the greater of 5 percent or $8.50 for all other drugs.

NOTE: Eligible beneficiaries must use network pharmacies to access prescription drug benefits, except in nonroutine circumstances. Quantity limits and restrictions may apply.

Compare Your Prescription Drug Benefits

You may get your drugs at network retail pharmacies and mail order pharmacies.

Standard Retail Cost-Sharing — 30-day Supply

Prominence Plus Plan Prominence Enhanced Plan
Prescription Drug Deductible No Deductible No Deductible
Phase 1: Initial Coverage
Tier 1 (Preferred Generic)
You pay $3 You pay $2
Tier 2 (Generic) You pay $12 You pay $10
Tier 3 (Preferred Brand) You pay $45 You pay $40
Tier 4 (Non-Preferred Drugs) You pay $100 You pay $100
Tier 5 (Specialty Drugs) You pay 33% You pay 33%
Tier 6 (Selected Drugs) You pay $0 You pay $0
Phase 2: Coverage Gap Tiers 1,2 and 6 are covered in the gap Tiers 1,2 and 6 are covered in the gap

Standard Mail Order Cost-Sharing — 90-day Supply

Prominence Plus Plan Prominence Enhanced Plan
Prescription Drug Deductible No Deductible No Deductible
Phase 1: Initial Coverage
Tier 1 (Preferred Generic)
You pay $6 You pay $4
Tier 2 (Generic) You pay $24 You pay $20
Tier 3 (Preferred Brand) You pay $135 You pay $120
Tier 4 (Non-Preferred Drugs) You pay $300 You pay $300
Tier 5 (Specialty Drugs) Not offered Not offered
Tier 6 (Selected Drugs) You pay $0 You pay $0
Phase 2: Coverage Gap Tiers 1,2 and 6 are covered in the gap Tiers 1,2 and 6 are covered in the gap

Cost-sharing may change if you enter another phase of the Part D benefit.

2018 Prescription Drug Coverage Resources

Understand and manage your prescription drug coverage.

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Last update 9/26/2018