This is archive material for research purposes. Please see
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2023 Medicare Prescription Drug Plan Cost-Sharing Details
| 2023 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
|
Wellcare Classic (PDP) (S4802-081-0) Benefit Details 
 all covered insulin pay $35 or less | ||||||
| This plan is available in CMS PDP Region 8 Click on a letter below to view the Wellcare Classic (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 |
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| 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: | $5.00 | $12.00 | $5.00 | $15.00 | $36.00 | $15.00 |
| Tier 3: Preferred Brand: | $30.00 | $40.00 | $30.00 | $90.00 | $120.00 | $90.00 |
| Tier 4: Non-Preferred Drug: | 39% | 40% | 39% | 39% | 40% | 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 $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 | ||||
| Go to the Wellcare Classic (PDP) 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 | ||||||