2012 Medicare Prescription Drug Plan Cost-Sharing Details

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2012 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Community CCRx Basic (PDP) (S5803-077-0)
Benefit Details        
This plan is available in CMS PDP Region 8

Click on a letter below to view the
Community CCRx Basic (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: Generic Drugs: $2.00 $2.00 n/a $6.00 $6.00 n/a
Tier 2: Preferred Brand Drugs: 25% 25% n/a 25% 25% n/a
Tier 3: Non-Preferred Brand Drugs: 47% 47% n/a 47% 47% n/a
Tier 4: Specialty Tier Drugs: 25% 25% n/a 25% 25% 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 Community CCRx Basic (PDP) 2012 Formulary Browser by choosing a letter below:
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