2011 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
Advantage Star Plan by RxAmerica (PDP) (S5644-080-0) Benefit Details | ||||||
This plan is available in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY Click on a letter below to view the Advantage Star Plan by RxAmerica (PDP) 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* | |
Initial Deductible Phase Cost Sharing | ||||||
All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
Initial Coverage Phase Cost-Sharing | ||||||
Tier 1: Generic: | $5.75 | $5.75 | $3.00 | $17.25 | $17.25 | $8.75 |
Tier 2: Preferred Brand: | 25% | 25% | 25% | 25% | 25% | 25% |
Tier 3: Non-Preferred Generic and Non-Preferred Brand: | 35% | 35% | 35% | 35% | 35% | 35% |
Tier 4: Specialty Tier: | 25% | 25% | n/a | n/a | n/a | n/a |
Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 7% Generic and 50% Brand Donut Hole Discount applies | ||||||
All Formulary Generic Drugs: | 93% | 93% | 93% | 93% | 93% | 93% |
All Formulary Brand-Name Drugs: | 50% | 50% | 50% | 50% | 50% | 50% |
Catastrophic Coverage Phase Cost Sharing | ||||||
Generic & Preferred Multi-Source Drugs: | The greater of 5% or $2.50 | The greater of 5% or $2.50 | ||||
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $6.30 | The greater of 5% or $6.30 | ||||
Go to the Advantage Star Plan by RxAmerica (PDP) 2011 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 |