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2012 Medicare Advantage Plan Prescription Drug Cost-Sharing Details
| 2012 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
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StartSmart with CareMore (HMO) (H0544-007-0) Benefit Details 
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| This plan is available in Los Angeles County, CA Click on a letter below to view the StartSmart with CareMore (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 |
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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: : | $5.00 | $5.00 | n/a | $15.00 | $15.00 | $12.50 |
| Tier 2: : | $8.00 | $8.00 | n/a | $24.00 | $24.00 | $20.00 |
| Tier 3: : | $45.00 | $45.00 | n/a | $135.00 | $135.00 | $112.50 |
| Tier 4: : | $95.00 | $95.00 | n/a | $285.00 | $285.00 | $237.50 |
| Tier 5: : | 33% | 33% | 33% | n/a | n/a | n/a |
| Tier 6: : | $35.00 | $35.00 | n/a | $105.00 | $105.00 | $87.50 |
| Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 14% Generic and 50% Brand Donut Hole Discount applies | ||||||
| All Formulary Generic Drugs: | 86% | 86% | 86% | 86% | 86% | 86% |
| 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 $2.60 | The greater of 5% or $2.60 | ||||
| Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $6.50 | The greater of 5% or $6.50 | ||||
| Go to the StartSmart with CareMore (HMO) 2012 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 | ||||||