Part D plans all have a list of medications they cover called a formulary. These formularies categorize your medication into tier levels that determine what you pay for each covered medication. Generally the lower the tier number, the less expensive your medication will be.

• Tier 1 - Preferred Generic $
• Tier 2 - Non-Preferred Generic $$
• Tier 3 - Preferred Brand Name $$$
• Tier 4 - Non-Preferred Brand Name $$$$
• Tier 5 - Specialty $$$$$
• Non-formulary medications are not covered and you will pay the full retail price for the medication
• Covered insulins are capped at $35 for a 1-month supply

Most Part D plans have a network of pharmacies they use to offer you your medications at a discounted rate. Some plans have both preferred and standard network pharmacies in their network. Many plans also offer a mail order service to have your medications shipped to you directly.

• Preferred pharmacies are in-network and offer the lowest co-payment or co-insurance price for your medications
• Standard pharmacies are in-network and offer a higher co-payment or co-insurance price for your medications
• Non-network pharmacies do not provide coverage for your medications, but certain plans may offer exceptions

• Not all plans have a deductible or they may have a lower deductible
• Some plans only charge deductible for higher tier medications
• Once your deductible is met, you move into the Initial Coverage stage

• Pay predictable co-payments or co-insurance for your medications depending on their tier level
• Once you have spent up to $2,100 out-of-pocket, you move into the Catastrophic Coverage stage

• You pay nothing for your covered medications for the remainder of the calendar year