2019 Medicare Advantage Plan Prescription Drug Cost-Sharing Details

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2019 Medicare Advantage Prescription Drug
Formulary (Drug List) Cost-Sharing Details
MMM - ELITE DADE (HMO) (H3293-001-0)
Benefit Details        
This plan is available in Miami-Dade County, FL

Monthly Premium: $0.00
Rx Deductible: $0
Initial Coverage Limit: $4,500


Click on a letter below to view the
MMM - ELITE DADE (HMO) Formulary
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  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/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $0.00 $0.00 n/a $0.00 $0.00 $0.00
Tier 2: Generic: $0.00 $0.00 n/a $0.00 $0.00 $0.00
Tier 3: Preferred Brand: $0.00 $0.00 n/a $0.00 $0.00 $0.00
Tier 4: Non-Preferred Drug: $5.00 $5.00 n/a $15.00 $15.00 $15.00
Tier 5: Specialty Tier: 33% 33% n/a n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
63% Generic and 75% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap
Tier 1: Preferred Generic: $0.00(A) $0.00(A) n/a $0.00(A) $0.00(A) $0.00(A)
Tier 2: Generic: $0.00(A) $0.00(A) n/a $0.00(A) $0.00(A) $0.00(A)
All Formulary Generic Drugs: 37% 37% 37% 37% 37% 37%
All Formulary Brand-Name Drugs: 25% 25% 25% 25% 25% 25%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $3.40 The greater of 5% or $3.40
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $8.50 The greater of 5% or $8.50
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 MMM - ELITE DADE (HMO) 2019 Formulary Browser by choosing a letter below:
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