This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
2011 Medicare Advantage Plan Prescription Drug Cost-Sharing Details
| 2011 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
|
SecureCare - Option II (HMO) (H5151-002-0) Benefit Details 
 | ||||||
| This plan is available in Harrison County, WV Click on a letter below to view the SecureCare - Option II (HMO) Formulary A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||
| 30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
|||||
| Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
| This plan does not have an Initial Deductible: | n/a | n/a | n/a | n/a | n/a | n/a |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1: : | $8.00 | $8.00 | n/a | $24.00 | $24.00 | $16.00 |
| Tier 2: : | $40.00 | $40.00 | n/a | $120.00 | $120.00 | $80.00 |
| Tier 3: : | 50% | 50% | n/a | 50% | 50% | 50% |
| Tier 4: : | 33% | 33% | 33% | n/a | n/a | n/a |
| Coverage Gap (Donut Hole) Phase Cost Sharing 7% Generic and 50% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap | ||||||
| Tier 1: : | n/a | |||||
| All Formulary Generic Drugs: | 93% | 93% | 93% | 93% | 93% | 93% |
| All Formulary Brand-Name Drugs: | 50% | 50% | 50% | 50% | 50% | 50% |
| Catastrophic Coverage Phase Cost Sharing | ||||||
| Generic & Preferred Multi-Source Drugs: | The greater of 5% or $2.50 | The greater of 5% or $2.50 | ||||
| Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $6.30 | The greater of 5% or $6.30 | ||||
| Notes: *The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing. (A) Coverage Gap cost-sharing applies to all drugs on the designated tier. Drugs that are covered in the coverage gap also receive the donut hole discount. (P) Coverage Gap cost-sharing applies to only some of drugs on the designated drug tier. Drugs that are covered in the coverage gap also receive the donut hole discount. | ||||||
| Go to the SecureCare - Option II (HMO) 2011 Formulary Browser by choosing a letter below: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||