2011 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
SecureRx - Option 3 (PDP) (S8067-001-0) Benefit Details | ||||||
This plan is available in CMS PDP Region 6 which includes: PA WV Click on a letter below to view the SecureRx - Option 3 (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/a | n/a | n/a | n/a | n/a | n/a |
Initial Coverage Phase Cost-Sharing | ||||||
Tier 1: Tier 1: | $9.00 | $9.00 | n/a | $22.00 | $22.00 | $22.00 |
Tier 2: Tier 2: | $52.00 | $52.00 | n/a | $130.00 | $130.00 | $130.00 |
Tier 3: Tier 3: | 33% | 33% | 33% | 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 SecureRx - Option 3 (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 |