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Prescription Drug Stages
Align Senior Care provides Medicare Part D prescription drug coverage through our partner Navitus Health Solutions, a full-service pharmacy benefit management company.
What do I pay?
The amount you pay depends on the payment stage you are in when you fill your prescription. Your payment stage changes during the calendar year based on your total drug costs.
Stage 1: Yearly Deductible
You pay for your drugs until you reach the deductible amount set by your plan. The deductible can apply to certain drug tiers or to all drug tiers (varies by plan). If your plan does not have a deductible, your coverage starts with the first prescription you fill.
Stage 2: Initial Coverage:
After the deductible, the plan will start to pay its share of the cost, and you pay your copay or coinsurance. You stay in this stage until your total drug cost (the amount paid by you and your plan) reaches $2,100.00
Stage 3: Catastrophic Coverage:
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,100.00, you pay nothing for your covered Part D prescription drugs.
If you take many medications for more than one chronic health condition you may be eligible to participate in the Medication Therapy Management (MTM) program offered by the Centers for Medicare and Medicaid Services.
Cost-sharing may differ based on point-of-service (retail, Long Term Care (LTC), home infusion), whether the pharmacy is in our standard network, or whether the prescription is a short-term (30-day supply) or long-term (90-day supply).