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| tier |
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A formulary is often divided into tiers. Each tier represents a different level of cost-sharing for prescription drugs. As the tiers rise, members pay more for the listed drugs. For example, a tier-1 drug may cost you a $7.50 copay, and a tier-3 drug may cost you a $50 copay. UnitedHealth Rx plans have four tiers, and your cost-sharing amount depends on which tier your drug is listed under.
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| total drug costs |
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"Total drug costs" is the total of all payments made for your covered Part D drugs.
It includes:
- What the plan pays.
- What you pay.
- What others (programs or organizations) pay for your drugs.
NOTE: if your plan offers Supplemental Drug Coverage for some drugs not generally covered by Medicare, the amounts paid for these drugs do not count toward your out-of-pocket costs or total drug costs.
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| TrOOP - True Out-of-Pocket |
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"True Out of pocket costs" or "Out of pocket costs"
includes:
- What you pay when you fill or refill a prescription for a covered Part D drug. (This includes payments for your drugs, if any, that are made by family or friends.)
- Payments made for your drugs by any of the following programs or organizations: "Extra Help" from Medicare, Medicare’s Coverage Gap Discount Program; Indian Health Service; AIDS drug assistance programs; most charities, and most State Pharmaceutical Assistance Programs (SPAPs).
It does NOT include:
- Payments made for:
- plan premiums,
- drugs not covered by our plan;
- non-Part D drugs (such as drugs you receive during a hospital stay);
- drugs covered by our plan’s Supplemental Drug Coverage;
- drugs obtained at a non-network pharmacy that does not meet our out-of-network pharmacy access policy.
- Payments made for your drugs by any of the following programs or organizations: employer or union health plans; some government-funded programs, including TRICARE and Veteran’s Administration; Worker’s Compensation, and some other programs
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Enroll 2010
