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2014 Medicare Prescription Drug Plan Cost-Sharing Details
| 2014 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
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Triple-S FarmaMed Plus (PDP) (S5907-002-0) Benefit Details 
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| This plan is available in CMS PDP Region 38 Monthly Premium: $88.70 Rx Deductible: $0 Initial Coverage Limit: $2,850 Qualifies for LIS: No Click on a letter below to view the Triple-S FarmaMed 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 |
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| Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
| This plan does not have an Initial Deductible: | n/a | n/a | n/a | n/a | n/a | n/a |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1: Preferred Generic: | $4.00 | $6.00 | n/a | $12.00 | $18.00 | $8.00 |
| Tier 2: Non-Preferred Generic: | $15.00 | $20.00 | n/a | $45.00 | $60.00 | $30.00 |
| Tier 3: Preferred Brand: | $35.00 | $40.00 | n/a | $105.00 | $120.00 | $70.00 |
| Tier 4: Non-Preferred Brand: | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 5: Specialty Tier: | 25% | 33% | n/a | 25% | 33% | 25% |
| Coverage Gap (Donut Hole) Phase Cost Sharing 28% Generic and 52.5% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap | ||||||
| Tier 1: Preferred Generic: | $4.00(A) | $6.00(A) | n/a | $12.00(A) | $18.00(A) | $8.00(A) |
| Tier 2: Non-Preferred Generic: | $15.00(A) | $20.00(A) | n/a | $45.00(A) | $60.00(A) | $30.00(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 $2.55 | 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. (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 Triple-S FarmaMed 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 | ||||||