2021 Medicare Prescription Drug Plan Cost-Sharing Details

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2021 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
WellCare Medicare Rx Saver (PDP) (S5810-059-0)
Benefit Details        
This plan is available in CMS PDP Region 25
which includes: IA MN MT NE ND SD WY

Monthly Premium: $36.50
Rx Deductible: $445
Initial Coverage Limit: $4,130 Qualifies for LIS: Yes


Click on a letter below to view the
WellCare Medicare Rx Saver (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 $1.00 $0.00 $0.00 $3.00 $0.00
Tier 2: Generic: $3.00 $6.00 $3.00 $9.00 $18.00 $7.50
Tier 3: Preferred Brand: $33.00 $42.00 $33.00 $99.00 $126.00 $82.50
Tier 4: Non-Preferred Drug: 39% 39% 39% 39% 39% 39%
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 -- 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 WellCare Medicare Rx Saver (PDP) 2021 Formulary Browser by choosing a letter below:
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