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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
First Health Part D Value Plus (PDP) (S5768-125-0)
Benefit Details        
This plan is available in CMS PDP Region 01
which includes: ME NH

Monthly Premium: $41.50
Rx Deductible: $0
Initial Coverage Limit: $2,850 Qualifies for LIS: No

Click on a letter below to view the
First Health Part D Value Plus (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*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $3.00 $10.00 n/a $9.00 $30.00 n/a
Tier 2: Non-Preferred Generic: $11.00 $33.00 n/a $33.00 $99.00 n/a
Tier 3: Preferred Brand: $37.00 $45.00 n/a $111.00 $135.00 n/a
Tier 4: Non-Preferred Brand: $88.00 $95.00 n/a $264.00 $285.00 n/a
Tier 5: Specialty Tier: 33% 33% n/a 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 First Health Part D Value Plus (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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