This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
2018 Medicare Prescription Drug Plan Cost-Sharing Details
| 2018 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
|
EnvisionRxPlus (PDP) (S7694-032-0) Benefit Details 
 | ||||||
| This plan is available in CMS PDP Region 32 Monthly Premium: $50.00 Rx Deductible: $405 Initial Coverage Limit: $3,750 Qualifies for LIS: No Click on a letter below to view the EnvisionRxPlus (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 | ||||||
| All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1: Preferred Generic: | $1.00 | $15.00 | $1.00 | $3.00 | $45.00 | $0.00 |
| Tier 2: Generic: | $3.00 | $18.00 | $3.00 | $9.00 | $54.00 | $4.50 |
| Tier 3: Preferred Brand: | 15% | 20% | 15% | 15% | 20% | 15% |
| Tier 4: Non-Preferred Drug: | 27% | 29% | 27% | 27% | 29% | 27% |
| 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 -- 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 EnvisionRxPlus (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 | ||||||