2017 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
McLaren Advantage Diamond (HMO) (H0141-004-2) Benefit Details | ||||||
This plan is available in Saginaw County, MI Monthly Premium: $132.00 Rx Deductible: $150 Initial Coverage Limit: $3,310 Click on a letter below to view the McLaren Advantage Diamond (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* | |
Initial Deductible Phase Cost Sharing | ||||||
All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
Initial Coverage Phase Cost-Sharing | ||||||
Tier 1: Generic: | $5.00 | $5.00 | n/a | $11.25 | $11.25 | n/a |
Tier 2: Preferred Brand: | $35.00 | $35.00 | n/a | $78.75 | $78.75 | n/a |
Tier 3: Non-Preferred Brand: | $85.00 | $85.00 | n/a | $191.25 | $191.25 | n/a |
Tier 4: Specialty Tier: | 29% | 29% | n/a | n/a | n/a | n/a |
Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 49% Generic and 60% Brand Donut Hole Discount applies | ||||||
All Formulary Generic Drugs: | 51% | 51% | 51% | 51% | 51% | 51% |
All Formulary Brand-Name Drugs: | 40% | 40% | 40% | 40% | 40% | 40% |
Catastrophic Coverage Phase Cost Sharing | ||||||
Generic & Preferred Multi-Source Drugs: | The greater of 5% or $3.30 | The greater of 5% or $3.30 | ||||
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $8.25 | The greater of 5% or $8.25 | ||||
Go to the McLaren Advantage Diamond (HMO) 2017 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 |