2018 Medicare Prescription Drug Plan Cost-Sharing Details

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2018 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
SilverScript Choice (PDP) (S5601-026-0)
Benefit Details        
This plan is available in CMS PDP Region 13
Monthly Premium: $29.10
Rx Deductible: $0
Initial Coverage Limit: $3,750 Qualifies for LIS: Yes


Click on a letter below to view the
SilverScript Choice (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*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $3.00 $7.00 $3.00 $7.50 $21.00 $0.00
Tier 2: Generic: $13.00 $20.00 $13.00 $32.50 $60.00 $32.50
Tier 3: Preferred Brand: $41.00 $47.00 $41.00 $102.50 $141.00 $102.50
Tier 4: Non-Preferred Drug: 41% 50% 41% 41% 50% 41%
Tier 5: Specialty Tier: 33% 33% 33% 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
Go to the SilverScript Choice (PDP) 2018 Formulary Browser by choosing a letter below:
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