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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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2016 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Express Scripts Medicare - Choice (PDP) (S5660-185-0)
Benefit Details        
This plan is available in CMS PDP Region 15
which includes: IN KY

Monthly Premium: $84.10
Rx Deductible: $360
Initial Coverage Limit: $3,310 Qualifies for LIS: No

Click on a letter below to view the
Express Scripts Medicare - Choice (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) $10.00(E) n/a(E) $3.00(E) $30.00(E) $0.00(E)
Tier 2: Generic: $5.00(E) $20.00(E) n/a(E) $15.00(E) $60.00(E) $5.00(E)
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: $1.00 $10.00 n/a $3.00 $30.00 $0.00
Tier 2: Generic: $5.00 $20.00 n/a $15.00 $60.00 $5.00
Tier 3: Preferred Brand: $42.00 $47.00 n/a $126.00 $141.00 $126.00
Tier 4: Non-Preferred Brand: 44% 46% n/a 44% 46% 46%
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 -- 42% Generic and 55% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 58% 58% 58% 58% 58% 58%
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 $2.95 The greater of 5% or $2.95
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $7.40 The greater of 5% or $7.40
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 Express Scripts Medicare - Choice (PDP) 2016 Formulary Browser by choosing a letter below:
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