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2013 Medicare Prescription Drug Plan Cost-Sharing Details
| 2013 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
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Express Scripts Medicare - Choice (PDP) (S5660-190-0) Benefit Details 
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| This plan is available in CMS PDP Region 20 Click on a letter below to view the Express Scripts Medicare - Choice (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 |
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| Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
| Initial Deductible Phase Cost Sharing | ||||||
| Tier 1: Generic Drugs: | $8.00 | $8.00 | n/a | $24.00 | $24.00 | $0.00 |
| Tier 2: Preferred Brand Drugs: | 100% | 100% | 100% | 100% | 100% | 100% |
| Tier 3: Non-Preferred Brand Drugs: | 100% | 100% | 100% | 100% | 100% | 100% |
| Tier 4: Specialty Tier Drugs: | 100% | 100% | 100% | 100% | 100% | 100% |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1: Generic Drugs: | $8.00 | $8.00 | n/a | $24.00 | $24.00 | $0.00 |
| Tier 2: Preferred Brand Drugs: | $45.00 | $45.00 | n/a | $135.00 | $135.00 | $113.00 |
| Tier 3: Non-Preferred Brand Drugs: | $95.00 | $95.00 | n/a | $285.00 | $285.00 | $238.00 |
| Tier 4: Specialty Tier Drugs: | 28% | 28% | 28% | n/a | n/a | n/a |
| Coverage Gap (Donut Hole) Phase Cost Sharing 21% Generic and 52.5% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap | ||||||
| Tier 1: Generic Drugs: | n/a | |||||
| 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 | ||||
| Notes: *The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing. (A) Coverage Gap cost-sharing applies to all drugs on the designated tier. Drugs that are covered in the coverage gap also receive the donut hole discount. (P) Coverage Gap cost-sharing applies to only some of drugs on the designated drug tier. Drugs that are covered in the coverage gap also receive the donut hole discount. | ||||||
| Go to the Express Scripts Medicare - Choice (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 | ||||||