2014 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS) (H2354-015-0) Benefit Details | ||||||
This plan is available in MIDLAND County, MI Monthly Premium: $0.00 Rx Deductible: $310 Initial Coverage Limit: $2,850 Click on a letter below to view the HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS) 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* | |
Initial Deductible Phase Cost Sharing | ||||||
All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
Initial Coverage Phase Cost-Sharing | ||||||
Tier 1: Generic: | $7.00 | $7.00 | $7.00 | $17.50 | $17.50 | $17.50 |
Tier 2: Preferred Brand: | $42.00 | $42.00 | $42.00 | $105.00 | $105.00 | $105.00 |
Tier 3: Non-Preferred Brand: | $95.00 | $95.00 | $95.00 | $237.50 | $237.50 | $237.50 |
Tier 4: Specialty Tier: | 25% | 25% | 25% | 25% | 25% | 25% |
Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 28% Generic and 52.5% Brand Donut Hole Discount applies | ||||||
All Formulary Generic Drugs: | 79% | 79% | 79% | 79% | 79% | 79% |
All Formulary Brand-Name Drugs: | 47.5% | 47.5% | 47.5% | 47.5% | 47.5% | 47.5% |
Catastrophic Coverage Phase Cost Sharing | ||||||
Generic & Preferred Multi-Source Drugs: | The greater of 5% or $2.55 | The greater of 5% or $2.55 | ||||
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $6.35 | The greater of 5% or $6.35 | ||||
Go to the HealthPlus MedicarePlus AdvantageHMO-POS Option 0 (HMO-POS) 2014 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 |