This is just a brief summary of the changes in your drug plan for 2012. If you have any questions, call Customer Services.
How will your prescription drug coverage change for 2012?
| |
Your current benefits 2011 |
Your Option for 2012 |
| Monthly Premium |
$78.40 |
$75.90 |
| Initial Deductible |
$0.00 |
$0.00 |
| Initial coverage limit (paid by you and the plan) |
$2,840 |
$2,930 |
| Copays & coinsurances |
Level 1 – Generic Drugs: $5.00
Level 2 – Preferred Drugs: $35.00
Tier 3-Brand Drugs:$50.00 copay
Tier 4-Non Preferred Brand Drugs: $50.00 copay or 25% coinsurance [whichever costs more]
Tier 5-Specialty Tier Drugs: 25% coinsurance |
Level 1 – Generic Drugs: $5.00
Level 2 – Preferred Drugs: $30.00
Tier 3-Non Preferred Brand Drugs: $40.00 copay or 25% coinsurance [whichever costs more]
Tier 4-Specialty Tier Drugs: 25% coinsurance |
| Gap |
$5 copay for generic drugs in Level 1; 7% discount for other generic drugs and 50% discount for brand drugs |
$5 copay for generic drugs in Level 1; 14% discount for other generic drugs and 50% discount for brand drugs |
| Out of pocket expenses before catastrophic coverage |
$4,550 |
$4,700 |
| Catastrophic Coverage |
After you have reach $4,550 out-of-pocket drugs cost, you pay the greater of 5% coinsurance or:
- $2.50 for generic drugs (including brand drugs treated as generic).
- $6.30 for all other drugs
|
After you have reach $4,700 out-of-pocket drugs cost, you pay the greater of 5% coinsurance or:
- $2.60 for generic drugs (including brand drugs treated as generic).
- $6.50 for all other drugs
|
Frequently Asked Questions from Triple-S FarmaMed (PDP) Members
Updated on: October 1, 2011
Triple-S FarmaMed (PDP) and Triple-S FarmaMed Plus (PDP) are stand-alone prescription drug plans with a Medicare contract. The plan is available to all Medicare beneficiaries with Parts A, B, or both that reside in the service area. Beneficiaries must use network pharmacies to access their prescription drug benefits, except in non-routine circumstances. Quantity limitations and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.
Y0082_WEB2012 CMS Approved MMDDYYYY; Pending CMS Approval
