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2023 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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2023 Medicare Advantage Prescription Drug
Formulary (Drug List) Cost-Sharing Details
MVP Medicare WellSelect Plus with Part D (PPO) (H9615-007-0)
Benefit Details        
all covered insulin pay $35 or less
This plan is available in Albany County, NY

Click on a letter below to view the
MVP Medicare WellSelect Plus with Part D (PPO) Formulary
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  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: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Tier 2: Generic: $10.00 $10.00 $10.00 $30.00 $30.00 $20.00
Tier 3: Preferred Brand: $35.00 $35.00 $35.00 $105.00 $105.00 $70.00
Tier 4: Non-Preferred Drug: 25% 25% 25% 25% 25% 25%
Tier 5: Specialty Tier: 33% 33% 33% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
75% Generic and 75% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap
Tier 1: Preferred Generic: $0.00(A) $0.00(A) $0.00(A) $0.00(A) $0.00(A) $0.00(A)
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 $4.15 The greater of 5% or $4.15
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $10.35 The greater of 5% or $10.35
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(A) Coverage Gap cost-sharing applies to all drugs on the designated tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
(P) Coverage Gap cost-sharing applies to only some of drugs on the designated drug tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
Go to the MVP Medicare WellSelect Plus with Part D (PPO) 2023 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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