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Medicare Prescription Drug Plan Cost-Sharing Details
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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2013 Medicare Advantage Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Today''s Options Premier Plus 350A (PFFS) (H5421-068-0)
Benefit Details        
This plan is available in GILA County, NE

Click on a letter below to view the
Today''s Options Premier Plus 350A (PFFS) 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
Preferred Pharmacy Standard Pharmacy Mail- Order* Preferred Pharmacy Standard Pharmacy Mail- Order*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $2.00 $2.00 $2.00 $5.00 $5.00 $4.00
Tier 2: Non-Preferred Generic: $7.00 $7.00 $7.00 $17.50 $17.50 $14.00
Tier 3: Preferred Brand: $40.00 $40.00 $40.00 $100.00 $100.00 $80.00
Tier 4: Non-Preferred Brand: $80.00 $80.00 $80.00 $200.00 $200.00 $160.00
Tier 5: Specialty Tier: 33% 33% 33% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage -- 21% Generic and 52.5% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 79% 79% 79% 79% 79% 79%
All Formulary Brand-Name Drugs: 47.5% 47.5% 47.5% 47.5% 47.5% 47.5%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $2.65 The greater of 5% or $2.65
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $6.60 The greater of 5% or $6.60
Go to the Today''s Options Premier Plus 350A (PFFS) 2013 Formulary Browser by choosing a letter below:
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