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2015 Medicare Prescription Drug Plan Cost-Sharing Details

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2015 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Humana Preferred Rx Plan (PDP) (S5884-134-0)
Benefit Details        
This plan is available in CMS PDP Region 9
Monthly Premium: $29.00
Rx Deductible: $320
Initial Coverage Limit: $2,960 Qualifies for LIS: Yes


Click on a letter below to view the
Humana Preferred Rx Plan (PDP) Formulary
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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
All Formulary Drug Tiers: 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $1.00 $3.00 $1.00 $3.00 $9.00 $0.00
Tier 2: Non-Preferred Generic: $2.00 $5.00 $2.00 $6.00 $15.00 $0.00
Tier 3: Preferred Brand: 20% 25% 20% 20% 25% 17%
Tier 4: Non-Preferred Brand: 35% 47% 35% 35% 47% 35%
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
Go to the Humana Preferred Rx Plan (PDP) 2015 Formulary Browser by choosing a letter below:
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