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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
EnvisionRxPlus Silver (PDP) (S7694-031-0)
Benefit Details        
This plan is available in CMS PDP Region 31
which includes: ID UT

Click on a letter below to view the
EnvisionRxPlus Silver (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
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: 25% 25% 25% n/a n/a n/a
Tier 2: Non-Preferred Generic: 25% 25% 25% n/a n/a n/a
Tier 3: Preferred Brand: 23% 23% 23% n/a n/a n/a
Tier 4: Non-Preferred Brand: 28% 28% 28% n/a n/a n/a
Tier 5: Specialty Tier: 25% 25% 25% 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 EnvisionRxPlus Silver (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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  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
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