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Medicare Prescription Drug Plan Cost-Sharing Details

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Go to this plan’s 2014 Formulary Browser by choosing a letter below:
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2014 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
WellCare Classic (PDP) (S5967-167-0)
Enroll in WellCare Classic (PDP).    
Monthly Plan Premium: $21.90   Deductible: $0   ICL: $2,850   Qualifies for LIS: Yes
This plan is available in CMS PDP Region 30, includes: OR WA
This Plan Uses Lower Cost-Sharing for Preferred Pharmacies

  30-Day Supply Cost-Sharing 90-Day Supply Cost-Sharing
Preferred Pharmacy Non- Preferred Mail- Order Preferred Pharmacy Non- Preferred 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 $8.00 $0.00 $0.00 $24.00 $0.00
Tier 2: Non-Preferred Generic: $12.00 $29.00 $12.00 $36.00 $87.00 $24.00
Tier 3: Preferred Brand: $40.00 $45.00 $40.00 $120.00 $135.00 $80.00
Tier 4: Non-Preferred Brand: $90.00 $95.00 $90.00 $270.00 $285.00 $180.00

 Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage 28% Generic and 52.5% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 72% 72% 72% 72% 72% 72%
All Formulary Brand-Name Drugs: 47.5% 47.5% 47.5% 47.5% 47.5% 47.5%

 Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $2.55 The greater of 5% or $2.55
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $6.35 The greater of 5% or $6.35
Go to this plan’s 2014 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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