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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
Community CCRx Choice (PDP) (S5803-162-0)
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
Community CCRx Choice (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: Generic and Preferred Brand: $0.00 $0.00 n/a $0.00 $0.00 n/a
Tier 2: Non-Preferred Generic/Preferred Brand: $35.00 $35.00 n/a $105.00 $105.00 n/a
Tier 3: Non-Preferred Generic/ Non-Preferred Brand: $65.00 $65.00 n/a $195.00 $195.00 n/a
Tier 4: Specialty Tier: 33% 33% n/a 33% 33% 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 Community CCRx Choice (PDP) 2011 Formulary Browser by choosing a letter below:
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