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Medicare prescription drug plans (PDP) in Pennsylvania provide quality coverage for Seniors. The different types of drugs are preferred generic (Tier 1), generic (Tier 2), preferred brand (Tier 3), non-preferred drug (Tier 4), and specialty (Tier 5). Prescription benefits are available through Medicare Advantage plans, or separate Part D coverage. All plans publish their specific covered drugs (formulary), which should be reviewed before enrollment, which is voluntary. Available pharmacies should also be considered. A unique ID is provided for each plan.
After you compare 2025 options and choose the specific plan you prefer, enrollment can be easily completed online, by phone, or through the mail. You will be required to provide your ID number (found on your Medicare Card), and the dates that your Parts A and B coverage began. If you have existing prescription drug benefits, you may not want to enroll in an Advantage plan. AARP, Aetna, and many carriers offer consumers multiple choices. MA-PD (Medicare Advantage plans with drug benefits) are also offered.
16 PDP plans are offered including 3 plans with a $0 deductible. Nine plans are enhanced (EA) and seven plans are basic (DS, AE, and BA). The least expensive $0 deductible plan costs $103.50 per month (AARP Medicare Rx Preferred from UHC). The range of monthly rates is $0 (least expensive) – $168.20 (most expensive). Six plans offer premiums that reduced this year and the average monthly rate of all plans is $71.53. Also, all Aetna plans are under WellCare.
The three $0 deductible plans are AARP Medicare Rx Preferred from UHC, Humana Premier Rx Plan, and Blue Rx PDP Complete. Six plans lowered their rates, while nine plans increased rates. The average monthly increase was $10.97. LIS Qualifying plans are WellCare Classic, SliverScript Choice, and Clear Spring Health Value Rx. The LIS Benchmark Premium is $48.36.
Penalty, Out-Of-Pocket Expenses, And Star Ratings
If you do not enroll during the time you initially become eligible, a late enrollment fee may be applied. The extra premium is added to your regular payment if you have a 63 day lapse in benefits. The penalty applies if you go without a Part D plan, a Part C plan, or another plan that provides coverage, or a “credible” plan. The penalty (national base beneficiary premium) is $32.74 times the number of full uncovered months. Members are always notified if they owe a penalty. Reconsideration of decisions are completed within 90 days.
The penalty can increase each year. You may request a reconsideration if you don’t agree with the penalty. A completed form is required to be received within 60 days from when you received official notification. Written proof should be submitted with your form.
The program was created by Federal Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003. The MMA also created subsidies and tax breaks to help lower-income households obtain benefits. Under the program, the SSA determines if an individual that is eligible for Part D benefits qualifies for a subsidy with income up to 15% of the Federal Poverty Level guidelines. Information may also be provided by the Office of Child Support Enforcement or the Department of Veterans Affairs.
Your out-of-pocket costs consist of the premium you pay, the annual deductible (if applicable), coinsurance, copayments, coverage gaps, and late enrollment fees (if deadline is missed). Using drugs that are on your plan formulary list will reduce your costs. Utilizing pharmacies inside your carrier’s network will also save money. Households with limited income may be eligible for financial assistance.
The 2025 deductible is $590 (up from $545 last year). The ICL (Initial Coverage Limit) no longer is applicable. Before 2025, you paid 25% of the cost of drugs until the ICL was reached. The coverage gap has also been eliminated and the out-of-pocket threshold is now $2,000. The total covered Part D out-of-pocket spending before entering the “catastrophic” coverage is $6,230.
Extra Help And Star Rating
“Extra Help” is offered if the household income is $22,590 (one person), or $30,660 (couple). The amount of resources may also impact eligibility. $17,220 in resources is allowed for a single person, and $34,360 is allowed for a married couple. Resources include funds in savings money market, and checking accounts, stocks, and bonds. Vehicles, primary homes, furniture, life insurance contracts,some non-business property, household items, and up to $1,500 for burial expenses are not included. Also not included is crime victim compensation, retroactive SS or SSI benefits, and housing assistance.
Applicants that qualify for Extra Help will pay $0 for their drug plan premium. The deductible is also $0 with a lower amount for generic and brand-name prescription drugs. Once qualified for benefits, there is no need to re-apply the following year. Applying online is an easy process since there are many self-help screens. The system will save your information if you can’t complete the process in one sitting. Before starting the application, keep resources and income information handy, and understand that family members may be able to help.
Documents can be sent directly to your plan. Examples include a green or yellow enrollment notice, an orange notice indicating the premium will change the following year, a purple notice that informs you that you have qualified, and a “Notice Of Award” from Social Security. Proof of Medicaid is provided with a state document, Medicaid card, Medicaid systems screen shot, and copy of state electronic file.
Medicare utilizes a star rating system to measure the performance of Part D plans. The highest rating is 5 stars, and the lowest possible rating is 1 star. Ratings are a valuable tool that helps consumers rate plans. Every year, ratings and reviews are updated to reflect current changes. The four rating categories are: Drug pricing and patient safety, member experience with the plan, member complaints, service problems and issues, and deciding to leave the plan, and customer service and relations.
If other benefits are in effect, it is important to understand the impact it will have on any new coverage. For example, benefits through TRICARE, your employer, the VA, or a special agreement with a drug manufacturer may be impacted by your choice of coverage. Also, if you receive your drugs through Medical Assistance, you must enroll in a Part D plan. Other insurance plans that work with Part D benefits include food stamps, Marketplace plans, COBRA, Medicaid, Long-term care facility, HUD assistance, Group and union benefits, and SS income benefits.
The Donut Hole Eliminated
The “Donut Hole” gap ended for 2025 with the passage of the IRA (Inflation Reduction Act). Out-of-pocket costs are now capped at $2,000 for Medicare Part D members. A manufacturer discount program also replaces the coverage gap discount program. The new three phase benefit includes a deductible phase, initial coverage phase, and a catastrophic phase. There is no initial coverage limit and the coverage gap discount program no longer exists. Beneficiary spending has reduced since more payments from third-party entities are treated as beneficiary out-of-pocket costs.
Prior to 205, once $4,660 (increased from $4,430) had been spent on drugs and the policy deductible, you were in the coverage gap (Donut Hole). Temporarily, there may have specified limits and out-of-pocket expenses on benefits. Brand name prescription drugs were be capped at 25% when you purchased them at a pharmacy or utilize mail-order options. However, 95% of the price and 70% of the company discount counted towards the $4,660. The out-of-pocket threshold was $7,400, an increase of $350 from the previous year. Total estimated covered Part D drug out-of-pocket spending was $11,206.28.
The reinsurance payment will decrease for a Part D beneficiary to 20% for brand name drugs and 40% for generic drugs from 80% of allowable reinsurance costs. A bigger risk-adjusted government subsidy is now paid up front. The average number of rate increases is now approximately $2 per month. Therefore, government subsidies to plans will pay a larger number of bid amounts.
Pennsylvania Prescription Assistance Programs For Older Adults
PACE – This program assists qualified persons (age 65 and above) receive prescription drugs at a reduced cost. PACE assists the application process by ensuring drugs are not misused, and helping with the submission of paperwork. The PA lottery helps with funding the program.
Applicants must be 65 years old or older, and lived in the Keystone State for at least 90 days prior to the application date. You also can not be receiving Medicaid prescription benefits. If single, income must be $14,500 or less. If married, household income must be $17,700 or less.
PACENET – Requirements are the same as PACE, except single income can be between $14,500 and $27,500, and married income can be between $17,700 and $35,500. Applications can be submitted by phone or online.
LIS Benchmark Premium
This premium is the maximum Medicare Part D premium that is paid by CMS for applicants that qualify for the “Extra Help” program or LIS (low-income subsidy). In Pennsylvania, if the premium is higher than $40.74 per month, the beneficiary pays the difference in premiums.
Shown below are all available Pa Medicare prescription drug plans offered. Premiums, deductibles, and copays are subject to change each year. CMS plan ratings apply to all plans. Five ratings are available. 5 stars (excellent), 4 stars (very good), 3 stars (good), 2 stars (fair) and 1 star (poor). A customer-service rating is also provided. “Member plan experience” indicates how available drugs are to covered members. New plans may not have a rating yet. These are “stand-alone” plans and are not designed to replace Parts A and B.
Humana Value Rx Plan – $39.80 monthly rate with $573 deductible (Tiers 1 and 2 not subject to deductible). 3,014 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $0 (Tier 2), 20% (Tier 3), 35% (Tier 4), and 26% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $0 (Tier 2), 25% (Tier 3), 35% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $0 (Tier 1), $0 (Tier 2), 25% (Tier 3), 35% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5884-185. 42,467 Pa residents are enrolled in this plan. 939,745 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Plan Formulary drugs include 264 in Tier 1, 569 in Tier 2, 617 in Tier 3, and 1,022 in Tier 4. CMS Region 06.
Humana Basic Rx Plan – $70.60 monthly rate with $590 deductible. 2,985 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $1 (Tier 2), 23% (Tier 3), 48% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $3 (Tier 2), 23% (Tier 3), 48% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $0 (Tier 1), $0 (Tier 2), 23% (Tier 3), 48% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5884-104. 13,486 Pa residents are enrolled in this plan. 517,758 persons in the entire US are enrolled in this plan. $0 premium is not available if full LIS benefits. Plan Formulary drugs include 211 in Tier 1, 582 in Tier 2, 644 in Tier 3, and 1,008 in Tier 4. CMS Region 06.
Humana Premier Rx – $128.90 monthly rate with $0 deductible. 3,089 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $4 (Tier 2), $45 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $12 (Tier 2), $135 (Tier 3), 50% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $0 (Tier 1), $0 (Tier 2), $125 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5884-152. 26,731 Pa residents are enrolled in this plan. 634,988 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Plan Formulary drugs include 370 in Tier 1, 493 in Tier 2, 655 in Tier 3, and 1,029 in Tier 4. CMS Region 06.
AARP Medicare Rx Walgreens from UHC – $68.50 monthly rate with $410 deductible (Tier 1 not subject to deductible). 3,253 formulary drugs available. Preferred 30-day drug copays are $2 (Tier 1), $8 (Tier 2), $40 (Tier 3), 50% (Tier 4), and 27% (Tier 5). Preferred 90-day drug copays are $6 (Tier 1), $24 (Tier 2), $120 (Tier 3), 50% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $6 (Tier 1), $24 (Tier 2), $120 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5921-388. 10,339 Pa residents are enrolled in this plan. 756,926 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Some gap coverage is available. Plan Formulary drugs include 245 in Tier 1, 488 in Tier 2, and 788 in Tier 3. CMS Region 06.
AARP Medicare Rx Rx Basic from UHC – $38.60 monthly rate with $545 deductible. 3,009 formulary drugs available. Preferred 30-day drug copays are $2 (Tier 1), $18 (Tier 2), 15% (Tier 3), 42% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $6 (Tier 1), $24 (Tier 2), 15% (Tier 3), 42% (Tier 4), and n/a (Tier 5). Preferred 90-day mail-order drug copays are $6 (Tier 1), $24 (Tier 2), 15% (Tier 3), 42% (Tier 4), and n/a (Tier 5). 3. 3.0-Star CMS Overall Star Rating. Plan ID is S5921-351. 27,568 Pa residents are enrolled in this plan. 586,201 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Plan Formulary drugs include 54 in Tier 1, 451 in Tier 2, and 799 in Tier 3. CMS Region 06.
AARP MedicareRx Preferred – $107.10 monthly rate with $0 deductible. 3,622 formulary drugs available. Preferred 30-day drug copays are $7 (Tier 1), $12 (Tier 2), $47 (Tier 3), 40% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $21 (Tier 1), $36 (Tier 2), $141 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5820-005. 30,704 Pa residents are enrolled in this plan. 1,334,095 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Plan Formulary drugs include 157 in Tier 1, 723 in Tier 2, and 1,013 in Tier 3. CMS Region 06.
Blue Rx PDP Plus – $108.80 monthly rate with $545 deductible. 4,089 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $7 (Tier 2), 20% (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $21 (Tier 2), 20% (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5593-002. 4,990 Pa residents are enrolled in this plan. 10,981 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 528 in Tier 1, 1,313 in Tier 2, and 621 in Tier 3. CMS Region 06.
Blue Rx PDP Complete – $195.10 monthly rate with $0 deductible. 4,089 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 35% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $15 (Tier 2), $120 (Tier 3), 35% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5593-003. 2,847 Pa residents are enrolled in this plan. 6,587 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage is available. Formulary drugs include 528 in Tier 1, 1,313 in Tier 2, and 621 in Tier 3. CMS Region 06.
Mutual Of Omaha Rx Premier – $88.20 monthly rate with $349 deductible. 3,050 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $10 (Tier 2), $47 (Tier 3), 36% (Tier 4), and 28% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $30 (Tier 2), $141 (Tier 3), n/a (Tier 4), and n/a (Tier 5). 1.5-Star CMS Overall Star Rating. Plan ID is S7126-075. 475 Pa residents are enrolled in this plan. 33,364 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage is not available. Formulary drugs include 201 in Tier 1, 603 in Tier 2, and 651 in Tier 3. CMS Region 06.
Mutual Of Omaha Rx Plus – $41.20 monthly rate with $545 deductible. 3,125 formulary drugs available. Preferred 30-day drug copays are $2 (Tier 1), $5 (Tier 2), 15% (Tier 3), 39% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $6 (Tier 1), $15 (Tier 2), 15% (Tier 3), n/a (Tier 4), and n/a (Tier 5). 1.5-Star CMS Overall Star Rating. Plan ID is S7126-005. 242 Pa residents are enrolled in this plan. 44,841 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage is not available. Formulary drugs include 206 in Tier 1, 742 in Tier 2, and 682 in Tier 3. CMS Region 06.
SilverScript Choice – $39.60 monthly rate with $505 deductible. 3,520 formulary drugs available. Preferred 30-day drug copays are $2 (Tier 1), $7 (Tier 2), 17% (Tier 3), 39% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $6 (Tier 1), $21 (Tier 2), 17% (Tier 3), 29% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-012. Low-income subsidy is available. 1110,100 Pa residents are enrolled in this plan. 2,876,329 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 250 in Tier 1, 1,200 in Tier 2, and 249 in Tier 3.
SilverScript Plus – $77.80 monthly rate with $0 deductible. 3,520 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-013. Low-income subsidy is not available. 15,348 Pa residents are enrolled in this plan. 400,896 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage available. Formulary drugs include 250 in Tier 1, 1,206 in Tier 2, and 318 in Tier 3.
SilverScript SmartSaver – $5.20 monthly rate with $505 deductible. 3,676 formulary drugs available. Preferred 30-day drug copays are $2 (Tier 1), $15 (Tier 2), 25% (Tier 3), 50% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $57 (Tier 2), $138 (Tier 3), 49% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5601-181. Low-income subsidy is not available. 71,504 Pa residents are enrolled in this plan. 1,201,863 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 250 in Tier 1, 615 in Tier 2, and 786 in Tier 3.
Cigna Secure Rx – $38.30 monthly rate with $505 deductible. 3,207 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $5 (Tier 2), $22 (Tier 3), 50% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $15 (Tier 2), $66 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5617-215. 42,506 Pa residents are enrolled in this plan. 897,502 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 142 in Tier 1, 489 in Tier 2, and 787 in Tier 3.
Cigna Extra Rx – $57.80 monthly rate with $100 deductible. 3,380 formulary drugs available. Preferred 30-day drug copays are $4 (Tier 1), $10 (Tier 2), $45 (Tier 3), 50% (Tier 4), and 31% (Tier 5). Preferred 90-day drug copays are $12 (Tier 1), $30 (Tier 2), $135 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5617-251. 14,561 Pa residents are enrolled in this plan. 348,220 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage available. Formulary drugs include 175 in Tier 1, 582 in Tier 2, and 889 in Tier 3.
Cigna Saver Rx – $12.40 monthly rate with $505 deductible. 3,326 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $10 (Tier 2), $40 (Tier 3), 50% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $30 (Tier 2), $120 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.0-Star CMS Overall Star Rating. Plan ID is S5617-285. 19,008 Pa residents are enrolled in this plan. 313,039 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 232 in Tier 1, 358 in Tier 2, and 1,205 in Tier 3.
WellCare Classic – $35.90 monthly rate with $480 deductible. 3,110 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $6 (Tier 2), $39 (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $8 (Tier 2), $117 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S4802-080. Low-income subsidy is available. 58,399 Pa residents are enrolled in this plan. 1,473,307 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 123 in Tier 1, 461 in Tier 2, and 1,094 in Tier 3.
WellCare Value Script – $12.90 monthly rate with $480 deductible (Tiers 1 and 2 not subject to deductible). 3,450 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $4 (Tier 2), $42 (Tier 3), 47% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $12 (Tier 2), $126 (Tier 3), 47% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S4802-141. 94,900 Pa residents are enrolled in this plan. 2,110,773 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 347 in Tier 1, 444 in Tier 2, and 1,033 in Tier 3.
WellCare Medicare Rx Value Plus – $69.00 monthly rate with $0 deductible. 3,470 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $4 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $12 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S5768-129. 24,530 Pa residents are enrolled in this plan. 577,317 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 363 in Tier 1, 433 in Tier 2, and 1,048 in Tier 3.
SecureRx – Option 3 – $43.30 monthly rate with $335 deductible. 2,830 formulary drugs available. Preferred 30-day drug copays are $5 (Tier 1), $12 (Tier 2), $40 (Tier 3), 50% (Tier 4), and 27% (Tier 5). Preferred 90-day drug copays are $15 (Tier 1), $36 (Tier 2), $120 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S8067-001. 1,489 Pa residents are enrolled in this plan. 1,733 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 116 in Tier 1, 496 in Tier 2, and 511 in Tier 3.
SecureRx – Option 1 – $90.50 monthly rate with $0 deductible. 3,564 formulary drugs available. Preferred 30-day drug copays are $3 (Tier 1), $10 (Tier 2), $38 (Tier 3), $88 (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $9 (Tier 1), $30 (Tier 2), $114 (Tier 3), $264 (Tier 4), and n/a (Tier 5). 4.0-Star CMS Overall Star Rating. Plan ID is S8067-003. 2,606 Pa residents are enrolled in this plan. 2,994 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 276 in Tier 1, 876 in Tier 2, and 796 in Tier 3.
Elixir RxPlus – $15.60 monthly rate with $445 deductible. 3,229 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $6 (Tier 2), $43 (Tier 3), 45% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $18 (Tier 2), $129 (Tier 3), 45% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S7694-126. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 206 in Tier 1, 625 in Tier 2, and 523 in Tier 3.
Elixir RxSecure – $35.00 monthly rate with $445 deductible. 3,168 formulary drugs available. Preferred 30-day drug copays are $1 (Tier 1), $7 (Tier 2), 15% (Tier 3), 35% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $3 (Tier 1), $21 (Tier 2), 15% (Tier 3), 34% (Tier 4), and n/a (Tier 5). 3.5-Star CMS Overall Star Rating. Plan ID is S7694-006. 107,164 Pa residents are enrolled in this plan. 844,835 persons in the entire US are enrolled in this plan. $0 premium available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 206 in Tier 1, 612 in Tier 2, and 501 in Tier 3.
Indy Health EliteRx – $47.10 monthly rate with $0 deductible. 3,578 formulary drugs available. Preferred 30-day drug copays are $3 (Tier 1), $5 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). Preferred 90-day drug copays are $9 (Tier 1), $15 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). Plan ID is S3535-005. 3,685 Pa residents are enrolled in this plan. 14,904 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 353 in Tier 1, 1,333 in Tier 2, and 327 in Tier 3.
Indy Health SaverRx – $34.00 monthly rate with $445 deductible. 3,219 formulary drugs available. Preferred 30-day drug copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 25% (Tier 5). Preferred 90-day drug copays are $0 (Tier 1), $30 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). Plan ID is S3535-009. 5,208 Pa residents are enrolled in this plan. 13,913 persons in the entire US are enrolled in this plan. $0 premium not available if full LIS benefits. Additional gap coverage not available. Formulary drugs include 353 in Tier 1, 1,251 in Tier 2, and 324 in Tier 3.
Persons with CRDP are helped by the Chronic Renal disease Program and Medicare Part D. From the day of eligibility, 63 days is provided to enroll. Otherwise, a lifetime late enrollment penalty may be imposed. Out-of-pocket costs for medications are reduced, and a confirmation letter will be sent.