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2011 Medicare Prescription Drug Plan Cost-Sharing Details

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2011 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Aetna Medicare Rx Premier (PDP) (S5810-188-0)
Sanctioned Plan        
This plan is available in CMS PDP Region 18
Click on a letter below to view the
Aetna Medicare Rx Premier (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: Tier 1: $2.00 $2.00 n/a $6.00 $6.00 $6.00
Tier 2: Tier 2: $20.00 $20.00 n/a $60.00 $60.00 $45.00
Tier 3: Tier 3: $25.00 $25.00 n/a $75.00 $75.00 $60.00
Tier 4: Tier 4: $60.00 $60.00 n/a $180.00 $180.00 $165.00
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 Premier (PDP) 2011 Formulary Browser by choosing a letter below:
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