Need a Specialized Medicare “Tier 6” Drug? 2023 Brings You Good News!

Paying for prescriptions while on Medicare is sometimes an expensive task. And when you need special-care drugs, your share of the costs can skyrocket depending on which plan you are enrolled in and your copays.

One exception is a series of special drugs known as Tier 6 prescriptions. Although this may seem confusing, as typically higher tiers are associated with higher out-of-pocket costs, coverage in a plan that includes Tier 6 allows you to actually pay less for these meds. These medications include some preventive vaccines as well as generic drugs for diabetes, high blood pressure and high cholesterol. Tier 6 drugs offer an affordable option to buy the most commonly needed drugs to treat these conditions.

Starting in 2023, HAP offers Tier 6 drugs with a $0 copay for up to a 90-day supply. This means you won’t have to pay anything out-of-pocket for these drugs. HAP offers this benefit during the initial coverage phase and through the coverage gap period. The coverage gap is a time when you and your drug plan have spent a certain amount on coverage drugs. When you leave the coverage gap, known as the donut hole, you will pay your catastrophic phase copay. Preventive vaccines are $0 copay through all phases of coverage.

See HAP’s list below that highlights drugs new to Tier 6 for 2023.

It’s important to know that most Medicare plans that offer Tier 6 drugs tend to cover only specific drugs. The easiest way to find out what Tier your drugs are in is by using your plan’s drug list also known as a formulary. HAP has these formularies online at hap.org/prescription-drug. When you look up a drug, the second column of the drug list will show you what tier it's in.

In addition to new savings opportunities in Tier 6, HAP has lowered the Tier and cost share for other common drugs, including some brand prescriptions for diabetes. Use your specialized formulary lists to make sure you get the best value from your pharmacy benefits. And when you use home delivery from Pharmacy Advantage, you get the benefit of HAP’s preferred mail-order pharmacy. This benefit includes a $0 copay for a 90-day supply of most Tier 1 and Tier 2 drugs purchased through mail order. Pharmacy Advantage also offers refill reminders and auto-shipment for convenience.

Being retired should mean you have less to worry about and more time to enjoy yourself.

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