2011 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | CVS Caremark Value (PDP) by SilverScript Insurance Company | ||||
State: | Colorado | ||||
Plan ID: | S5601 - 054 - 0 Click to see other plans | ||||
Member Services: | 1-866-235-5660 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 |
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Email a copy of the CVS Caremark Value (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $31.40 | ||||
Annual Deductible: | $310 | ||||
$0 Premium if Full LIS Benefits? | Yes, this plan does qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,840 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 2,830 drugs | Browse the CVS Caremark Value (PDP) Formulary | |||
This plan has 4 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: | $5.00 | $42.00 | $95.00 | 25% | |
• Number of Drugs per Tier: | 1750 | 813 | 57 | 210 | |
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Colorado: | 5,215 members (CMS Region 27) | ||||
Number of Members enrolled in this plan nationally: | 622,963 members |