2012 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
First Health Part D Value Plus (PDP) (S5768-148-0) 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 First Health Part D Value Plus (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: Preferred Generic Drugs: | $0.00 | $7.00 | n/a | $0.00 | $21.00 | n/a |
Tier 2: Preferred Brand Drugs: | 25% | 37% | n/a | 25% | 37% | n/a |
Tier 3: Non-Preferred Brand Drugs: | 39% | 58% | n/a | 39% | 58% | n/a |
Tier 4: Specialty Tier Drugs: | 33% | 33% | 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 First Health Part D Value Plus (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 |