Prescription drug coverage is included on CHPW Medicare Advantage (MA) Plans 1, 2, 3, 4 and Dual Plans (D-SNP). Our coverage uses a tiered cost-sharing system. You pay either a fixed copay amount or a percentage of the total cost.

Prescription Cost-Sharing Tiers

Tier 1 represents the lowest cost generic drugs and Tier 5 represents the highest cost brand drugs and potent drugs that may require monitoring.

• Tier 1: Preferred Generic – includes lowest cost preferred generic drugs
• Tier 2: Generic – includes preferred generic drugs
• Tier 3: Preferred Brand – includes preferred brand drugs and non-preferred generic drugs
• Tier 4: Non-Preferred – includes non-preferred brand drugs and non-preferred generic drugs
• Tier 5: Specialty Tier – includes high cost and brand name drugs

Prescription Pricing

We can help you decide which tier of coverage you need based on the current medications you take. If you’re a current member, please call 1-800-942-0247 (TTY: 711). For prospective members, please call 1-800-944-1247 (TTY: 711). We’re here for you seven days a week, 8:00 a.m. to 8:00 p.m.

To discuss which prescription medications you need, contact your primary care provider or pharmacist.

And keep in mind—for the lowest copays, use a preferred pharmacy.

Medicare Advantage Dual Plans (Dual Complete and Dual Select)

Please see the prescription drug coverage page for more information about which specific medications are covered.

Preferred pharmacy options for Dual Complete (HMO D-SNP)

$0 (for generic drugs) $0 (all other drugs)

Preferred pharmacy options for Dual Select (HMO D-SNP)

$0 (for generic drugs) $0 (all other drugs)

Medicare Advantage Plans 1, 2, 3, 4 (HMO)

Preferred pharmacy

30-day supply cost 90-day supply cost Tier 1: $0 copay Tier 1: $0 copay Tier 2: $10 copay Tier 2: $20 copay Tier 3: $37 copay Tier 3: $110 copay Tier 4: 50% coinsurance Tier 4: only available at a 30-day supply Tier 5: 29% coinsurance after deductible for MA Plan 1; 33% coinsurance for MA Plans 2, 3, 4 Tier 5: only available at a 30-day supply

Standard pharmacy

30-day supply cost 90-day supply cost Tier 1: $10 copay Tier 1: $20 copay Tier 2: $20 copay Tier 2: $40 copay Tier 3: $47 copay Tier 3: $140 copay Tier 4: 50% coinsurance Tier 4: only available at a 30-day supply Tier 5: 29% coinsurance after deductible for MA Plan 1; Tier 5: only available at a 30-day supply 33% coinsurance for MA Plans 2, 3, 4

Get the most of your prescription benefits

Additional highlights include:

• 90-day supply of select medications used to treat chronic conditions (e.g., high blood pressure, diabetes, depression)
• Free home delivery
• Searchable and printable prescription drug formularies (lists of covered drugs)
• Coverage accepted at more 1,000 Washington State pharmacies and more than 50,000 pharmacies nationwide

Eligibility criteria may apply. ➔ Learn more about Prescription Drug Coverage.

We’re here to help.

To ask questions, request print copies of materials, and more, contact Customer Service at 1-800-942-0247 (TTY: 711), 8:00 a.m. to 8:00 p.m., 7 days a week.