2011 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
CVS Caremark Value (PDP) (S5601-002-0) Benefit Details ![]() ![]() ![]() | ||||||
This plan is available in CMS PDP Region 01 which includes: ME NH Click on a letter below to view the CVS Caremark Value (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* | |
Initial Deductible Phase Cost Sharing | ||||||
All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
Initial Coverage Phase Cost-Sharing | ||||||
Tier 1: Generic Drugs: | $5.00 | $5.00 | $2.50 | $15.00 | $15.00 | $7.50 |
Tier 2: Preferred Brand Drugs: | $45.00 | $45.00 | $33.75 | $135.00 | $135.00 | $101.25 |
Tier 3: Non-Preferred Generic and Non-Preferred Brand Drugs: | $95.00 | $95.00 | $87.25 | $285.00 | $285.00 | $261.25 |
Tier 4: Specialty Tier Drugs: | 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 CVS Caremark Value (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 |