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2011 Medicare Prescription Drug Plan Cost-Sharing Details
| 2011 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
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UA Medicare Part D Prescription Drug Cov (PDP) (S5755-005-0) Benefit Details 
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| This plan is available in CMS PDP Region 01 which includes: ME NH Click on a letter below to view the UA Medicare Part D Prescription Drug Cov (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 |
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| Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
| Initial Deductible Phase Cost Sharing | ||||||
| Tier 1: Generic: | $10.00 | $10.00 | n/a | $28.00 | $28.00 | $26.00 |
| Tier 2: Preferred Brand Name: | 100% | 100% | 100% | 100% | 100% | 100% |
| Tier 3: Non-Preferred Brand Name: | 100% | 100% | 100% | 100% | 100% | 100% |
| Tier 4: Specialty: | 100% | 100% | 100% | 100% | 100% | 100% |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1: Generic: | $10.00 | $10.00 | n/a | $28.00 | $28.00 | $26.00 |
| Tier 2: Preferred Brand Name: | $45.00 | $45.00 | n/a | $113.00 | $113.00 | $90.00 |
| Tier 3: Non-Preferred Brand Name: | $95.00 | $95.00 | n/a | $238.00 | $238.00 | $190.00 |
| Tier 4: Specialty: | 31% | 31% | n/a | 31% | 31% | 31% |
| 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 UA Medicare Part D Prescription Drug Cov (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 | ||||||