This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
2021 Medicare Advantage Plan Prescription Drug Cost-Sharing Details
| 2021 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
|
Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan) (H7172-001-0) Benefit Details 
 | ||||||
| This plan is available in Butler County, OH Monthly Premium: $0.00 Rx Deductible: $0 Initial Coverage Limit: $0 Click on a letter below to view the Aetna Better Health of Ohio, MyCare Ohio (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 |
|||||
| 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% | n/a | 0% | 0% | n/a |
| 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 Aetna Better Health of Ohio, MyCare Ohio (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 | ||||||