2011 Medicare Prescription Drug Plan Cost-Sharing Details

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2011 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Aetna Medicare Rx Essentials (PDP) (S5810-035-0)
Sanctioned Plan        
This plan is available in CMS PDP Region 01
which includes: ME NH


Click on a letter below to view the
Aetna Medicare Rx Essentials (PDP) Formulary
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  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: Tier 1: $5.00 $5.00 n/a $15.00 $15.00 $15.00
Tier 2: Tier 2: $26.00 $26.00 n/a $78.00 $78.00 $63.00
Tier 3: Tier 3: $27.00 $27.00 n/a $81.00 $81.00 $66.00
Tier 4: Tier 4: $70.00 $70.00 n/a $210.00 $210.00 $195.00
Tier 5: Tier 5: 25% 25% n/a 25% 25% 25%
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 Aetna Medicare Rx Essentials (PDP) 2011 Formulary Browser by choosing a letter below:
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