2019 Medicare Prescription Drug Plan Cost-Sharing Details

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2019 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
SilverScript Choice (PDP) (S5601-008-0)
Benefits & Contact Info        
This plan is available in CMS PDP Region 4
Monthly Premium: $35.20
Rx Deductible: $0
Initial Coverage Limit: $3,820 Qualifies for LIS: Yes


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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 $9.00 $21.00 $0.00
Tier 2: Generic: $14.00 $20.00 $14.00 $42.00 $60.00 $35.00
Tier 3: Preferred Brand: $43.00 $47.00 $43.00 $129.00 $141.00 $107.50
Tier 4: Non-Preferred Drug: 47% 50% 47% 47% 50% 47%
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 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
Go to the SilverScript Choice (PDP) 2019 Formulary Browser by choosing a letter below:
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