This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
2016 Medicare Prescription Drug Plan Cost-Sharing Details
| 2016 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
|
Blue Shield Medicare Enhanced Plan (PDP) (S2468-004-0) Benefit Details 
 | ||||||
| This plan is available in CMS PDP Region 32 Monthly Premium: $100.50 Rx Deductible: $0 Initial Coverage Limit: $3,310 Qualifies for LIS: No Click on a letter below to view the Blue Shield Medicare Enhanced Plan (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* | |
| 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 | $13.00 | n/a | $8.00 | $39.00 | $8.00 |
| Tier 2: Generic: | $10.00 | $17.00 | n/a | $20.00 | $51.00 | $20.00 |
| Tier 3: Preferred Brand: | $40.00 | $47.00 | n/a | $80.00 | $141.00 | $80.00 |
| Tier 4: Non-Preferred Brand: | 38% | 40% | n/a | 38% | 40% | 38% |
| Tier 5: Injectable Drugs: | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 6: Specialty Tier: | 33% | 33% | 33% | 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 | ||||
| Go to the Blue Shield Medicare Enhanced Plan (PDP) 2016 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 | ||||||