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Medicare Prescription Drug Plan Cost-Sharing Details
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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2011 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
First Health Part D Premier Plus (PDP) (S5670-084-0)
Benefit Details        
This plan is available in CMS PDP Region 16
Click on a letter below to view the
First Health Part D Premier Plus (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
Preferred Pharmacy Standard Pharmacy Mail- Order* Preferred Pharmacy Standard Pharmacy Mail- Order*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $0.00 $0.00 n/a $0.00 $0.00 $0.00
Tier 2: Generic: $25.00 $25.00 n/a $75.00 $75.00 $62.50
Tier 3: Preferred Brand: 30% 30% n/a 30% 30% 27%
Tier 4: Non-Preferred Generic and Non-Preferred Brand: 57% 57% n/a 57% 57% 57%
Tier 5: Specialty Tier: 33% 33% n/a n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
7% Generic and 50% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap
Tier 1: Preferred Generic: n/a
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
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(A) Coverage Gap cost-sharing applies to all drugs on the designated tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
(P) Coverage Gap cost-sharing applies to only some of drugs on the designated drug tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
Go to the First Health Part D Premier Plus (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 
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