Stages of Pharmacy Coverage There are three pharmacy coverage stages, but most people stay in the initial coverage stage.
Most people stay in this range $4,130 Few people reach this stage $6,550 Even fewer people reach this stage
Initial Coverage You pay the following until the amount you pay plus the amount we pay reaches $4,130: • Tier
1: $2. 2: $15. • Tier 3: $47. • Tier 4: 50%. • Tier 5: 33%. • Tier
Coverage Gap Also known as the “donut hole,” this stage begins when the amount you pay plus the amount we pay for your prescription drugs reaches $4,130. Here, you pay the following until you reach $6,550:
Catastrophic Coverage This stage begins when your outof-pocket drug costs reach $6,550. Here, we pay for most of your drug costs for the rest of the year, while you pay the greater of the following: • 5%
• 25% • 25%
for covered generic drugs. for covered brand-name drugs.
of the cost. or • $3.70 for covered generic drugs (including brand-name drugs treated as generic) and $9.20 for covered brand-name drugs.