2012 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
CVS Caremark Value (PDP) (S5601-062-0) Benefit Details | ||||||
This plan is available in CMS PDP Region 31 which includes: ID UT Click on a letter below to view the CVS Caremark Value (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 | ||||||
All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
Initial Coverage Phase Cost-Sharing | ||||||
Tier 1: Generic Drugs: | $5.75 | $5.75 | $3.00 | $17.25 | $17.25 | $8.75 |
Tier 2: Preferred Brand Drugs: | $45.00 | $45.00 | $33.75 | $135.00 | $135.00 | $101.25 |
Tier 3: Non-Preferred Brand Drugs: | $95.00 | $95.00 | $87.25 | $285.00 | $285.00 | $261.25 |
Tier 4: Specialty Tier Drugs: | 25% | 25% | n/a | n/a | n/a | n/a |
Coverage Gap (Donut Hole) Phase Cost Sharing Plan offers no Gap Coverage -- 14% Generic and 50% Brand Donut Hole Discount applies | ||||||
All Formulary Generic Drugs: | 86% | 86% | 86% | 86% | 86% | 86% |
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 $2.60 | The greater of 5% or $2.60 | ||||
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $6.50 | The greater of 5% or $6.50 | ||||
Go to the CVS Caremark Value (PDP) 2012 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 |