1. 406 POINTS
    Coby Higgins
    Licensed Independent Agent, Texas Insurance Alliance, Little Elm, TX
    Prescriptions are covered under a Part D plan (prescription drug plan) or Part C plan (medicare advantage plan). Every plan has a unique formulary that determines what tier each medication is categorized as or if it is even covered by the plan. Typically brand drugs are a tier 3 or higher and have a higher copay when filled at your in-network pharmacy. Some brand drugs have a generic alternative which puts them at a tier 1 or tier 2 which usually has a lower copay. Some plans provide for $0 copay for generics or at least a discount on your copays if you use a mail order pharmacy and may allow you to receive up to a 90 day supply of your medications. Be sure to read about any applicable prescription deductibles and coverage gaps/catastrophic gaps (commonly called 'the donut hole') that may apply to these plans as that may cause the copays to change.
    Answered on October 31, 2015
  2. 521 POINTS
    Edward Crowe
    Owner, Crowe and Associates, Brookfield, CT
    Cymbalta will have different costs with each Part D RX plan or the Rx plans built inherently into Medicare Advantage Plans (Part C plans). Each plan has a formulary which tiers the drugs and then ties each tier to a copay. You will not find Cymbalta in a lower copay tier with most carriers as they will all have it listed as a tier 3 or tier 4 medication. There are some plans that have lower copays associated with tier 3 however. Most companies charge a $45 to $50 copay for a one month supply of a tier 3 drug. There are some plans that have a $18 to $25 copay for tier three which could save you some money.

    The last thing to keep in mind is regardless of the copay amount, a drug like Cymbalta is going to push you into the Part D coverage gap "donut hole" much faster than a lower cost generic would do.
    Answered on February 21, 2016
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