2019 Medicare Prescription Drug Plan Cost-Sharing Details

Send this chart to my email
Receive our free Part D Newsletter
2019 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
EnvisionRxPlus (PDP) (S7694-011-0)
Benefit Details        
This plan is available in CMS PDP Region 11
Monthly Premium: $66.70
Rx Deductible: $415
Initial Coverage Limit: $3,820 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: 28% 34% 28% 28% 34% 28%
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 EnvisionRxPlus (PDP) 2019 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 
Send this chart to my email
Receive our free Part D Newsletter