2010 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | EnvisionRxPlus Gold (PDP) by EnvisionRx Plus | ||||
State: | Louisiana | ||||
Plan ID: | S7694 - 055 - 0 Click to see other plans | ||||
Member Services: | 1-866-250-2005 TTY users 1-866-763-9630 | ||||
— 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 |
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Email a copy of the EnvisionRxPlus Gold (PDP) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $43.30 | ||||
Annual Deductible: | $150 | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,830 | ||||
Gap Coverage? | No Gap Coverage | ||||
Total Number of Formulary Drugs: | 2,336 drugs | Browse the EnvisionRxPlus Gold (PDP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $4.00 | $30.00 | $25.00 | 25% | 25% |
• Number of Drugs per Tier: | 1359 | 198 | 298 | 365 | 116 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Louisiana: | 63 members (CMS Region 21) | ||||
Number of Members enrolled in this plan nationally: | 5,299 members |