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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 Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Blue Shield Medicare Basic Plan (PDP) (S2468-003-0)
Benefit Details        
This plan is available in CMS PDP Region 32
Click on a letter below to view the
Blue Shield Medicare Basic Plan (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
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: Preferred Generic: $4.00 $4.00 n/a $8.00 $12.00 $8.00
Tier 2: Preferred Brand: $37.00 $37.00 n/a $74.00 $111.00 $74.00
Tier 3: Non-Preferred Brand: $76.00 $76.00 n/a $152.00 $228.00 $152.00
Tier 4: Injectable Drugs: 25% 25% n/a 25% 25% 25%
Tier 5: Specialty Tier: 25% 25% n/a 25% 25% 25%
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 Blue Shield Medicare Basic Plan (PDP) 2013 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 
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