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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
SilverScript Choice (PDP) (S5601-062-0)
Benefit Details        
This plan is available in CMS PDP Region 31
which includes: ID UT

Monthly Premium: $32.00
Rx Deductible: $0
Initial Coverage Limit: $2,960 Qualifies for LIS: Yes

Click on a letter below to view the
SilverScript Choice (PDP) Formulary
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  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: Generic: $8.00 $8.00 $8.00 $20.00 $20.00 $20.00
Tier 2: Preferred Brand: $33.00 $33.00 $33.00 $82.50 $82.50 $82.50
Tier 3: Non-Preferred Brand: 42% 42% 42% 42% 42% 42%
Tier 4: Specialty Tier: 33% 33% 33% 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
Go to the SilverScript Choice (PDP) 2015 Formulary Browser by choosing a letter below:
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