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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
MedicareRx Rewards Standard (PDP) (S5960-140-0)
Benefit Details        
This plan is available in CMS PDP Region 34
Monthly Premium: $50.70
Rx Deductible: $310
Initial Coverage Limit: $2,850 Qualifies for LIS: No

Click on a letter below to view the
MedicareRx Rewards Standard (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
Tier 1: Preferred Generic: $1.00(E) $9.00(E) $1.00(E) $3.00(E) $27.00(E) $2.00(E)
Tier 2: Non-Preferred Generic: 100% 100% 100% 100% 100% 100%
Tier 3: Preferred Brand: 100% 100% 100% 100% 100% 100%
Tier 4: Non-Preferred Brand: 100% 100% 100% 100% 100% 100%
Tier 5: Injectable Drugs: 100% 100% 100% 100% 100% 100%
Tier 6: Specialty Tier: 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $1.00 $9.00 $1.00 $3.00 $27.00 $2.00
Tier 2: Non-Preferred Generic: $2.00 $10.00 $2.00 $6.00 $30.00 $4.00
Tier 3: Preferred Brand: $28.00 $33.00 $28.00 $84.00 $99.00 $84.00
Tier 4: Non-Preferred Brand: $79.00 $84.00 $79.00 $237.00 $252.00 $237.00
Tier 5: Injectable Drugs: 25% 25% 25% 25% 25% 25%
Tier 6: Specialty Tier: 25% 25% 25% 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
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(E) Drugs on this tier are excluded from the Initial Deductible and do not count toward meeting the deductible.
Go to the MedicareRx Rewards Standard (PDP) 2014 Formulary Browser by choosing a letter below:
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