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2019 Medicare Prescription Drug Plan Cost-Sharing Details
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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2019 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Express Scripts Medicare - Saver (PDP) (S5660-224-0)
Benefit Details        
This plan is available in CMS PDP Region 8
Monthly Premium: $23.90
Rx Deductible: $415
Initial Coverage Limit: $3,820 Qualifies for LIS: No

Click on a letter below to view the
Express Scripts Medicare - Saver (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
Tier 1: Preferred Generic: $1.00(E) $10.00(E) n/a(E) $3.00(E) $30.00(E) $2.00(E)
Tier 2: Generic: $4.00(E) $13.00(E) n/a(E) $12.00(E) $39.00(E) $8.00(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 $10.00 n/a $3.00 $30.00 $2.00
Tier 2: Generic: $4.00 $13.00 n/a $12.00 $39.00 $8.00
Tier 3: Preferred Brand: 18% 21% n/a 18% 21% 18%
Tier 4: Non-Preferred Drug: 32% 34% 34% n/a n/a n/a
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 -- 63% Generic and 75% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 37% 37% 37% 37% 37% 37%
All Formulary Brand-Name Drugs: 25% 25% 25% 25% 25% 25%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $3.40 The greater of 5% or $3.40
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $8.50 The greater of 5% or $8.50
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 Express Scripts Medicare - Saver (PDP) 2019 Formulary Browser by choosing a letter below:
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