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2021 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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2021 Medicare Advantage Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Health Alliance Medicare Guide HMO Rx 2 (HMO) (H1463-021-0)
Benefit Details        
select insulin pay $2-$35 copay
This plan is available in Henry County, IL

Monthly Premium: $0.00
Rx Deductible: $0
Initial Coverage Limit: $4,130

Click on a letter below to view the
Health Alliance Medicare Guide HMO Rx 2 (HMO) 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 
  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: $2.00 $2.00 $2.00 $6.00 $6.00 $4.00
Tier 2: Generic: $15.00 $15.00 $15.00 $45.00 $45.00 $30.00
Tier 3: Preferred Brand: $47.00 $47.00 $47.00 $141.00 $141.00 $94.00
Tier 4: Non-Preferred Drug: 50% 50% 50% 50% 50% 50%
Tier 5: Specialty Tier: 33% 33% 33% 33% 33% 33%
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage -- 75% Generic and 75% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 25% 25% 25% 25% 25% 25%
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 $3.70 The greater of 5% or $3.70
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $9.20 The greater of 5% or $9.20
Go to the Health Alliance Medicare Guide HMO Rx 2 (HMO) 2021 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 
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