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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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2014 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Asuris Medicare Script Basic (PDP) (S5609-001-0)
Benefit Details        
This plan is available in CMS PDP Region 30
which includes: OR WA

Monthly Premium: $88.50
Rx Deductible: $200
Initial Coverage Limit: $2,850 Qualifies for LIS: No

Click on a letter below to view the
Asuris Medicare Script Basic (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: $7.00 $7.00 $7.00 $21.00 $21.00 $14.00
Tier 2: Non-Preferred Generic: $33.00 $33.00 $33.00 $99.00 $99.00 $66.00
Tier 3: Preferred Brand: $45.00 $45.00 $45.00 $135.00 $135.00 $112.50
Tier 4: Non-Preferred Brand: $90.00 $90.00 $90.00 $270.00 $270.00 $225.00
Tier 5: Specialty Tier: 27% 27% 27% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage -- 28% 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 $2.55 The greater of 5% or $2.55
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $6.35 The greater of 5% or $6.35
Go to the Asuris Medicare Script Basic (PDP) 2014 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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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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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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  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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