Medicare Prescription Drug Plan

Medicare members pay the applicable copayment or the cost of the drug, whichever is less, in the Initial Coverage Stage. There are certain medications that MCHCP covers at 100%¹, when accompanied by a prescription and filled at an Express Scripts Medicare network pharmacy. For more information, see Preventive Services.

Description	Tier	Retail 31-day supply	Retail 60-day supply	Retail 90-day supply	Home Delivery 90-day supply
Initial Coverage Stage	Tier 1 Preferred Generic drugs	Home Delivery (90-day supply) — $10 copayment	Retail (31-day supply) — $20 copayment	Retail (60-day supply) — $30 copayment	Retail (90-day supply) — $25 copayment
	Tier 2 Preferred Brand drugs	Home Delivery (90-day supply) — $40 copayment	Retail (31-day supply) — $80 copayment	Retail (60-day supply) — $120 copayment	Retail (90-day supply) — $100 copayment
	Tier 3 Non-preferred drugs	Home Delivery (90-day supply) — $100 copayment	Retail (31-day supply) — $200 copayment	Retail (60-day supply) — $300 copayment	Retail (90-day supply) — $250 copayment
Catastrophic Coverage Stage	After annual out-of-pocket drug costs reach $2,000, members will have $0 cost-share. Amounts paid for non-Part D drugs covered under this plan will not count toward annual out-of-pocket drug costs and you will continue to pay a copayment.

Drugs covered at 100% (Generic or Preferred 100 percent, Non-Preferred $100 copayment) are those described in the United States Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the CDC, and HRSA Guidelines for women, as well as children, including the American Academy of Pediatrics Bright Futures periodicity guidelines.

Benefit Chart

State Members

Medicare Prescription Drug Plan (PDP)

ABOUT MCHCP

USEFUL LINKS

STAY CONNECTED