2022 Prescription Coverage
During the Initial Coverage Stage, the plan pays its share of the cost of your covered prescription drugs, and you pay your share (your copayment or coinsurance amount). Your share of the cost will vary depending on the drug and where you fill your prescription. Below is a summary of your copay amount based on drug tier.
| Retail 30-day supply | Retail 90-day supply | Mail Order 30-day supply | Mail Order 90-day supply | |
|---|---|---|---|---|
| Care N’ Care Choice Premium (PPO) | ||||
| Tier 1 – Preferred Generics Tier 2 – Generics Tier 3 – Preferred Brands – Select Insulins* Tier 4 – Non-Preferred Drugs Tier 5 – Specialty Drugs | $0 copay $10 copay $40 copay $35 copay $90 copay 33% of cost | $0 copay $20 copay $80 copay $70 copay $180 copay 33% of cost | $0 copay $10 copay $40 copay $35 copay $90 copay 33% of cost | $0 copay $20 copay $80 copay $70 copay $180 copay 33% of cost |
| Care N’ Care Choice Plus (PPO) | ||||
| Tier 1 – Preferred Generics Tier 2 – Generics Tier 3 – Preferred Brands – Select Insulins* Tier 4 – Non-Preferred Drugs Tier 5 – Specialty Drugs | $2 copay $12 copay $45 copay $35 copay $95 copay 33% of cost | $4 copay $24 copay $90 copay $70 copay $190 copay 33% of cost | $0 copay $12 copay $45 copay $35 copay $95 copay 33% of cost | $0 copay $24 copay $90 copay $70 copay $190 copay 33% of cost |
| Care N’ Care Choice (PPO) | ||||
| Tier 1 – Preferred Generics Tier 2 – Generics Tier 3 – Preferred Brands – Select Insulins* Tier 4 – Non-Preferred Drugs Tier 5 – Specialty Drugs | $4 copay $14 copay $47 copay $35 copay $100 copay 33% of cost | $8 copay $28 copay $94 copay $70 copay $200 copay 33% of cost | $0 copay $14 copay $47 copay $35 copay $100 copay 33% of cost | $0 copay $28 copay $94 copay $70 copay $200 copay 33% of cost |
| Care N’ Care Classic (HMO) | ||||
| Tier 1 – Preferred Generics Tier 2 – Generics Tier 3 – Preferred Brands – Select Insulins* Tier 4 – Non-Preferred Drugs Tier 5 – Specialty Drugs | $0 copay $12 copay $45 copay $35 copay $100 copay 33% of cost | $0 copay $24 copay $90 copay $70 copay $200 copay 33% of cost | $0 copay $12 copay $45 copay $35 copay $100 copay 33% of cost | $0 copay $24 copay $90 copay $70 copay $200 copay 33% of cost |
| Southwestern Health Select (HMO) | ||||
| Tier 1 – Preferred Generics Tier 2 – Generics Tier 3 – Preferred Brands – Select Insulins* Tier 4 – Non-Preferred Drugs Tier 5 – Specialty Drugs | $0 copay $10 copay $40 copay $35 copay $100 copay 33% of cost | $0 copay $20 copay $80 copay $70 copay $200 copay 33% of cost | $0 copay $0 copay $40 copay $35 copay $100 copay 33% of cost | $0 copay $0 copay $80 copay $70 copay $200 copay 33% of cost |
* Tier 3 – Select Insulins: You can identify Select Insulins by the abbreviation “SSM” found in the “Notes & Restrictions” column here.
Here’s a definition of the five drug tiers:
- Tier 1 – Preferred Generics: (This is the lowest cost tier): Includes generic drugs that are available at the lowest cost share for this plan.
- Tier 2 – Generics: Includes generic drugs that are available at a higher cost to you than drugs in Tier 1. Also includes some very low cost brand drugs.
- Tier 3 – Preferred Brands: Includes preferred brand name drugs that are available at a lower cost to you than drugs in Tiers 4 and 5. Also includes some high cost generic medications which are available at a higher cost to you than drugs in Tiers 1 and 2.
- Tier 4 – Non-Preferred Drugs: Includes brand and generic drugs that are available at a higher cost to you than drugs in Tier 3.
- Tier 5 – Specialty Drugs: (This is the highest-cost tier): Includes some injectables and other high-cost drugs.
Extra Help
You may be able to get extra help to pay for your prescription drug premiums and/or copays. To see if you qualify, call or contact:
- 1-800-Medicare (1-800-633-4227). (TTY: 1-877-486-2048) anytime
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m. (EST) Monday through Friday. TTY:1-800-325-0778
- The Texas Medicaid Office
For additional prescription drug benefit details, please refer to your Evidence of Coverage found in Plan Documents.
