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2011 Medicare Advantage Plan Prescription Drug Cost-Sharing Details
| 2011 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
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Medicare Plus Blue PPO Signature (PPO) (H9572-001-5) Benefit Details 
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| This plan is available in Oceana County, MI Click on a letter below to view the Medicare Plus Blue PPO Signature (PPO) 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 | ||||||
| This Plan Uses Lower Cost-Sharing for Preferred Pharmacies | ||||||
| 30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
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| 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: : | $3.00 | $3.00 | $3.00 | $7.50 | $9.00 | $7.50 |
| Tier 2: : | $40.00 | $40.00 | $40.00 | $100.00 | $120.00 | $100.00 |
| Tier 3: : | $95.00 | $95.00 | $95.00 | $237.50 | $285.00 | $237.50 |
| Tier 4: : | 25% | 25% | 25% | n/a | n/a | n/a |
| Tier 5: : | 25% | 25% | n/a | n/a | n/a | n/a |
| Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 7% Generic and 50% Brand Donut Hole Discount applies | ||||||
| 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 | ||||
| Go to the Medicare Plus Blue PPO Signature (PPO) 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 | ||||||