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2025 Medicare Prescription Drug Plan Cost-Sharing Details
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2025 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Wellcare Value Script (PDP) (S4802-162-0)
Benefits & Contact Info        
all covered insulin pay $35 or less
This plan is available in CMS PDP Region 31
which includes: ID UT

Click on a letter below to view the
Wellcare Value Script (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
Tier 1: Preferred Generic: $0.00(E) $10.00(E) $0.00(E) $0.00(E) $30.00(E) $0.00(E)
Tier 2: Generic: $5.00(E) $15.00(E) $5.00(E) $15.00(E) $45.00(E) $15.00(E)
Tier 3: Preferred Brand: 100% 100% 100% 100% 100% 100%
Tier 4: Non-Preferred Drug: 100% 100% 100% 100% 100% 100%
Tier 5: Specialty Tier: 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $0.00 $10.00 $0.00 $0.00 $30.00 $0.00
Tier 2: Generic: $5.00 $15.00 $5.00 $15.00 $45.00 $15.00
Tier 3: Preferred Brand: 25% 25% 25% 25% 25% 25%
Tier 4: Non-Preferred Drug: 42% 43% 42% 42% 43% 42%
Tier 5: Specialty Tier: 25% 25% 25% n/a n/a n/a
Catastrophic Coverage Phase Cost Sharing
All Formulary Drugs:


 $0 cost-sharing.
The Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP).
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(E) Drugs on this tier are excluded from the Initial Deductible and do not count toward meeting the deductible.
Go to the Wellcare Value Script (PDP) 2025 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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