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2019 Medicare Prescription Drug Plan Cost-Sharing Details

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2019 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
WellCare Classic (PDP) (S4802-083-0)
Benefit Details        
This plan is available in CMS PDP Region 11
Monthly Premium: $31.30
Rx Deductible: $415
Initial Coverage Limit: $3,820 Qualifies for LIS: Yes


Click on a letter below to view the
WellCare Classic (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
All Formulary Drug Tiers: 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $0.00 $5.00 $0.00 $0.00 $15.00 $0.00
Tier 2: Generic: $1.00 $6.00 $1.00 $3.00 $18.00 $2.50
Tier 3: Preferred Brand: $34.00 $45.00 $34.00 $102.00 $135.00 $85.00
Tier 4: Non-Preferred Drug: 38% 48% 38% 38% 48% 38%
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
Go to the WellCare Classic (PDP) 2019 Formulary Browser by choosing a letter below:
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