The SilverScript (Employer PDP) Medicare Part D Plan sponsored by Standard Plan Features


Prescription Benefit Network Retail
(up to 30-day supply)
Network Mail Service
(up to 90-day supply)
Annual Deductible N/A
Initial Coverage Level The plan pays its share of the cost of your drugs and you pay your share of the cost. You stay in this stage until your payments for the year plus the plan’s payments total $2,960.
 
Prescription Benefit Network Retail
(up to 30-day supply)
Network Mail Service
(up to 90-day supply)
Preferred Generic Drugs 20% w/$20 max $7.50
Generic Drugs 20% w/$20 max $7.50
Preferred Brand Drugs 20% w/$25 max $25.00
Non-Preferred Brand Drugs 40% w/$50 max $50.00
Specialty Drugs Applicable tier copay apply N/A
 
Coverage Gap  Your plan offers a reduced level of coverage through the coverage gap. You qualify for Catastrophic Coverage once you reach an out-of-pocket cost of $4,700.00.
Preferred Generic Drugs 20% w/$20 max $7.50
Generic Drugs 20% w/$20 max $7.50
Preferred Brand Drugs 20% w/$25 max $25.00
Non-Preferred Brand Drugs 40% w/$50 max $50.00
Specialty Drugs Applicable tier copay apply N/A
 
Catastrophic Coverage
You qualify for Catastrophic Coverage once your true out-of-pocket (also known as TrOOP) costs reach $4,700.00 for the year. During Catastrophic Coverage you will pay no more than: the greater of 5% coinsurance or $2.65 for generics (or drugs treated as generic) and $6.60 for all other drugs. The Plan will pay the rest.
Generics (including brand drugs treated as generic) $2.65 or 5%
All other drugs $6.60 or 5%
 Out-of-Network Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan’s service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy’s full charge for the drug and submit documentation to receive reimbursement from SilverScript (Employer PDP) for its share of the costs. Please refer to your Evidence of Coverage for more information.

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