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2010 Medicare Prescription Drug Plan Benefit Details for the AdvantraRx Value (PDP)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2010 Medicare Prescription Drug Plan Details
Medicare Plan Name:AdvantraRx Value (PDP)
   by Coventry AdvantraRx
State:Wisconsin
Plan ID:S5670 - 081 - 0     Click to see other plans
Member Services:1-866-823-5177 TTY users 1-866-236-1069
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the AdvantraRx Value (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$30.60
Annual Deductible:$100
$0 Premium if LIS Benefits?No, this plan does NOT qualify for the $0 Premium.
Annual Initial Coverage Limit (ICL):$2,830
Drug Benefit Type ❔Enhanced Alternative (EA)
Gap Coverage?No Gap Coverage
Total Number of Formulary Drugs:2,811 drugsBrowse the AdvantraRx Value (PDP) Formulary
This plan has 4 drug tiers. See cost-sharing highlights below.
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$6.0019%65%30% 
• Number of Drugs per
  Tier:		1538421592260
Plan Offers Mail Order?Yes
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Wisconsin:15,213 members     (CMS Region 16)
Number of Members enrolled in this plan nationally:444,884 members




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