SilverScript Choice (PDP)
Contract S5601, plan 004, segment 0 · offered by SILVERSCRIPT INSURANCE COMPANY · CMS PDP Region 02 (Rhode Island).
Plan features
| Monthly premium | $32.70 |
|---|---|
| Annual deductible | $615.00 |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,715 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Rhode Island | 6,285 |
| Members nationally | 120,130 |
| Member services | (866)235-5660TTY 711 |
| Pharmacy search | www.aetna.com/medicare |
| BIN / PCN | 004336 / MEDDADVSee BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 3 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S5601 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $2.00 | 464 |
| Tier 2 | $10.00 | 917 |
| Tier 3 | 19% | 418 |
| Tier 4 | 35% | 1,100 |
| Tier 5 | 25% | 816 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $2.00 | $2.00 | $2.00 | $6.00 | $6.00 | $6.00 |
| Tier 2: Generic | $10.00 | $10.00 | $10.00 | $30.00 | $30.00 | $30.00 |
| Tier 3: Preferred Brand | 19% | 19% | 19% | 19% | 19% | 19% |
| Tier 4: Non-Preferred Drug | 35% | 35% | 35% | 35% | 35% | 35% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 2: Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 3: Preferred Brand | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 4: Non-Preferred Drug | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 5: Specialty Tier | 0% | 0% | 0% | 0% | 0% | 0% |
Plan facts come from the CMS quarterly prescription drug plan public use files.