2018 Medicare Prescription Drug Plan Cost-Sharing Details

Send this chart to my email
Receive our free Part D Newsletter
2018 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
First Health Part D Premier Plus (PDP) (S5768-185-0)
Benefit Details        
This plan is available in CMS PDP Region 01
which includes: ME NH

Monthly Premium: $96.80
Rx Deductible: $0
Initial Coverage Limit: $3,750 Qualifies for LIS: No


Click on a letter below to view the
First Health Part D Premier Plus (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/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $1.00 $10.00 $1.00 $3.00 $30.00 $3.00
Tier 2: Generic: $2.00 $20.00 $2.00 $6.00 $60.00 $6.00
Tier 3: Preferred Brand: $35.00 $47.00 $35.00 $105.00 $141.00 $105.00
Tier 4: Non-Preferred Drug: 42% 50% 42% 42% 50% 42%
Tier 5: Specialty Tier: 33% 33% 33% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
56% Generic and 65% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap
Tier 1: Preferred Generic: $1.00(A) $10.00(A) $1.00(A) $3.00(A) $30.00(A) $3.00(A)
Tier 2: Generic: $2.00(A) $20.00(A) $2.00(A) $6.00(A) $60.00(A) $6.00(A)
Tier 4: Non-Preferred Drug: 42%(P) 50%(P) 42%(P) 42%(P) 50%(P) 42%(P)
All Formulary Generic Drugs: 44% 44% 44% 44% 44% 44%
All Formulary Brand-Name Drugs: 35% 35% 35% 35% 35% 35%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $3.35 The greater of 5% or $3.35
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $8.35 The greater of 5% or $8.35
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(A) Coverage Gap cost-sharing applies to all drugs on the designated tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
(P) Coverage Gap cost-sharing applies to only some of drugs on the designated drug tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
Go to the First Health Part D Premier Plus (PDP) 2018 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 
Send this chart to my email
Receive our free Part D Newsletter