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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
MedicareRx Rewards Standard (PDP) (S5960-131-0)
Benefit Details        
This plan is available in CMS PDP Region 25
which includes: IA MN MT NE ND SD WY

Click on a letter below to view the
MedicareRx Rewards Standard (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 Preferred Generic Drugs: $4.00 $4.00 n/a $12.00 $12.00 $6.00
Tier 2: Tier 2 Non-Preferred Generic Drugs: $7.00 $7.00 n/a $21.00 $21.00 $10.50
Tier 3: Tier 3 Preferred Brand Drugs: $38.00 $38.00 n/a $114.00 $114.00 $95.00
Tier 4: Tier 4 Injectable Drugs : 25% 25% n/a 25% 25% 25%
Tier 5: Tier 5 Specialty Tier Drugs : 25% 25% 25% 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 MedicareRx Rewards Standard (PDP) 2011 Formulary Browser by choosing a letter below:
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