2018 Medicare Prescription Drug Plan Cost-Sharing Details

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2018 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Aetna Medicare Rx Saver (PDP) (S5810-035-0)
Benefit Details        
This plan is available in CMS PDP Region 01
which includes: ME NH

Monthly Premium: $28.80
Rx Deductible: $300
Initial Coverage Limit: $3,750 Qualifies for LIS: Yes


Click on a letter below to view the
Aetna Medicare Rx Saver (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
Tier 1: Preferred Generic: $1.00(E) $6.00(E) $1.00(E) $3.00(E) $18.00(E) $3.00(E)
Tier 2: Generic: $2.00(E) $13.00(E) $2.00(E) $6.00(E) $39.00(E) $6.00(E)
Tier 3: Preferred Brand: 100% 100% 100% 100% 100% 100%
Tier 4: Non-Preferred Drug: 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 $6.00 $1.00 $3.00 $18.00 $3.00
Tier 2: Generic: $2.00 $13.00 $2.00 $6.00 $39.00 $6.00
Tier 3: Preferred Brand: $30.00 $30.00 $30.00 $90.00 $90.00 $90.00
Tier 4: Non-Preferred Drug: 35% 35% 35% 35% 35% 35%
Tier 5: Specialty Tier: 27% 27% 27% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage 56% Generic and 65% Brand Donut Hole Discount applies
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.
(E) Drugs on this tier are excluded from the Initial Deductible and do not count toward meeting the deductible.
Go to the Aetna Medicare Rx Saver (PDP) 2018 Formulary Browser by choosing a letter below:
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