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2017 Prescription Drug Plans

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See to your prescription needs

A prescription drug plan comes standard with Vital Traditions (HMO) and Vital Traditions (HMO-POS). The HMO option is available with no monthly premium ($0). If you want even more choice, Vital Traditions (HMO-POS) has a low $20 monthly premium. Both plans offer:

  • Hundreds of 2017 in-network pharmacies across Texas
  • Convenient home delivery mail order service
  • 90-day supply of maintenance drugs, available for two copayments
  • Access to a complete range of generic and brand-name drugs
Plan Type Vital Traditions (HMO) and Vital Traditions (HMO-POS)
Initial Coverage Amount $3,700
Deductible $100
Copays During Initial Coverage Period
 Tier 1 — Preferred Generic Drugs $2
 Tier 2 — Non-Preferred Generic Drugs $10
 Tier 3 — Preferred Brand Drugs $45
 Tier 4 — Non-Preferred Brand Drugs $95
 Tier 5 — Specialty Drugs  31%
Coverage Gap
Generic Drugs 51%
Brand Drugs
40%
All Other Drugs
100% 
Total Out-of-Pocket you pay before Catastrophic Coverage $4,950
Catastrophic Coverage Amounts You Pay the Greater of:
Generic Drugs (including brand drugs treated as generic)
All Other Drugs
5% or
$3.30
$8.25

 


The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Members must use network pharmacies to access their prescription drug benefit except under non-routine circumstances, and quantity limitations and restrictions may apply. Our network of pharmacies has both local and chain pharmacies. You can fill prescriptions at either.