Retiree - Medicare-Eligible Prescription Drug Benefit
Prescription Drug Benefit Coverage Levels
Drugs in our formulary are organized into different drug tiers or groups of drug types. Your coinsurance depends upon the tier in which your drug is placed. Please look at the 2008 Medicare Formulary to determine the "tier" placement of your medication.
Prescription Coinsurance Rates (Amount Paid by Retiree)*
Coverage Level |
Retail Pharmacy (including Kentucky Clinic Pharmacy**) 30 or 90-day supply |
Express Scripts Home Delivery Pharmacy (mail order only) |
Tier 1: Includes most generic drugs. Generics usually cost less than brand name drugs. |
20% |
10% |
Tier 2: Includes many brand name drugs. |
40% |
30% |
Tier 3: Includes brand name drugs that have a higher coinsurance. (Check with your prescribing health care professional or the UK Benefits Pharmacists at (859) 323-1493 to see if there are alternatives in Tier 1 or 2 that may be less costly to you.) |
50% |
40% |
Tier 4: This specialty tier includes unique or very high-cost drugs. |
$100 per 30 days | $100 per 30 days |
*Minimums and Maximums have been removed to conform to the Medicare plan design.
**NOTE: In order to use the Kentucky Clinic Pharmacy, you will need to have an active UK medical record. This means you must be seen by a UK Physician at least once a year.
Yearly Deductible for Drug Coverage
This is the amount you pay for your prescriptions before your plan starts to share in the costs. There is NO annual deductible for your UK Medicare Prescription Drug Benefit.
Coverage "Gap"
Please note: Your coverage is continuous. Many Medicare drug plans may have a "coverage gap," which is sometimes called the "donut hole." This means that after you have spent a certain amount of money for covered drugs, you have to pay all costs for your drugs while you are in this "gap." Unlike many other Medicare prescription drug plans, there is NO coverage "gap" or "donut hole" in the UK Medicare Prescription Drug Benefit.
Catastrophic Coverage
Once you have reached the plan's true out-of-pocket limit (also known as TrOOP), you will have "catastrophic coverage." In the 2008 calendar year, once you have spent $4,050 out-of-pocket on covered prescription drugs, you will pay the greater of 5% or $2.25 for generic drugs. For all other drugs, you will pay the greater of 5% or $5.60.
