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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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PICA Primero (PDP) (S5775-001-0) Benefit Details 
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| This plan is available in CMS PDP Region 38 Click on a letter below to view the PICA Primero (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 | ||||||
| This Plan Uses Lower Cost-Sharing for Preferred Pharmacies | ||||||
| 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* | |
| 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: | $2.00 | $4.50 | $2.00 | $6.00 | $13.50 | $6.00 |
| Tier 2: Tier 2: | $25.00 | $30.00 | $25.00 | $75.00 | $90.00 | $72.50 |
| Tier 3: Tier 3: | $50.00 | $55.00 | $50.00 | $150.00 | $165.00 | $145.00 |
| Tier 4: Tier 4: | 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 PICA Primero (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 | ||||||