2021 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
Absolute Total Care (Medicare-Medicaid Plan) (H1723-001-0) Benefit Details | ||||||
This plan is available in Abbeville County, SC Monthly Premium: $0.00 Rx Deductible: $0 Initial Coverage Limit: $0 Click on a letter below to view the Absolute Total Care (Medicare-Medicaid Plan) 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: : | 0% | 0% | 0% | 0% | 0% | 0% |
Tier 2: : | 0% | 0% | 0% | 0% | 0% | 0% |
Tier 3: : | 0% | 0% | 0% | 0% | 0% | 0% |
Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 75% Generic and 75% Brand Donut Hole Discount applies | ||||||
All Formulary Generic Drugs: | 25% | 25% | 25% | 25% | 25% | 25% |
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 $3.70 | The greater of 5% or $3.70 | ||||
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $9.20 | The greater of 5% or $9.20 | ||||
Go to the Absolute Total Care (Medicare-Medicaid Plan) 2021 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 |