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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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2015 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
WellCare Classic (PDP) (S5967-168-0)
Benefit Details        
This plan is available in CMS PDP Region 31
which includes: ID UT

Monthly Premium: $42.80
Rx Deductible: $320
Initial Coverage Limit: $2,960 Qualifies for LIS: No

Click on a letter below to view the
WellCare Classic (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: $0.00(E) $9.00(E) $0.00(E) $0.00(E) $27.00(E) $0.00(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: Specialty Tier: 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $0.00 $9.00 $0.00 $0.00 $27.00 $0.00
Tier 2: Non-Preferred Generic: $4.00 $29.00 $4.00 $12.00 $87.00 $10.00
Tier 3: Preferred Brand: $40.00 $45.00 $40.00 $120.00 $135.00 $100.00
Tier 4: Non-Preferred Brand: $89.00 $95.00 $89.00 $267.00 $285.00 $222.50
Tier 5: Specialty Tier: 25% 25% 25% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage -- 35% Generic and 55% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 65% 65% 65% 65% 65% 65%
All Formulary Brand-Name Drugs: 45% 45% 45% 45% 45% 45%
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.
(E) Drugs on this tier are excluded from the Initial Deductible and do not count toward meeting the deductible.
Go to the WellCare Classic (PDP) 2015 Formulary Browser by choosing a letter below:
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