SilverScript Insurance Company Medicare Prescription · PDF fileSilverScript Insurance Company...

©2009 SilverScript®. All rights reserved.

SilverScript Insurance CompanyMedicare Prescription Drug Plan

Safety. Savings. Service.

2010 Plan Year

S5601_10_80008 CMS Approval Date 10/26/2009

©2009 SilverScript®. All rights reserved. 2

Medicare Overview• The government organization that administers the Medicare and

Medicaid programs is the Center for Medicare & Medicaid Services(CMS)

• Medicare is the national health insurance program. Medicare is governed by the federal government.

• Medicaid is a federal program that provides medical benefits to qualifying low-income people, some of whom may have no other medical insurance or inadequate other medical insurance. Although Medicaid is jointly funded by state and federal government, it is managed at the state level. Eligibility requirements, application processes and program names vary state by state as each state runs their program differently.


Medicare Overview• Medicare consists of 4 parts

– Part A: Hospital Insurance– Part B: Medical Insurance– Part D: Prescription Drug Program– Part C: Medicare Advantage

Part C

Part D

Part B

Part A

Medicare


Medicare Part A – Hospital Insurance• Helps cover inpatient hospital stays

including critical access hospitals and skilled nursing facilities

• Does not cover custodial or long-term care

• Beneficiaries must meet certain criteria to receive benefits

• Most beneficiaries do not pay a premium for Part A because they (or their spouse) paid for it through payroll taxes while working

Part C

Part D

Part B

Part A

Medicare


Medicare Part B – Medical Insurance• Helps cover doctors’ services and

outpatient care • Covers some services not covered

by Part A such as physical and occupational therapy as well as home health care when medically necessary

• Most beneficiaries pay a monthly premium for Part B

Part C

Part D

Part B

Part A

Medicare


Medicare Part D – Prescription Drug Program• Created as a part of the Medicare

Modernization Act of 2003• Coverage began January 1, 2006 • Most beneficiaries pay a premium

based on plan benefit• Part D is administered through

private health plans such as SilverScript Insurance

• Part D is voluntary and individuals must elect to join.

• If you do not join a Part D plan when you are first eligible, you may have to pay a penalty

Part C

Part D

Part B

Part A

Medicare


Medicare Part C – Medicare Advantage Plan• Offered by private health insurance

companies • HMOs and PPOs combine

Medicare Parts A and B or Parts A, B and D into one comprehensive plan (the Part D portion of which is called an MA-PD plan)

• Most beneficiaries pay a monthly premium for Part C.

• Part C plans generally offer extra benefits compared to original Medicare, and many include prescription drug coverage benefits

Part C

Part D

Part B

Part A

Medicare


Medigap (Medicare Supplement) Policies• A Medigap policy is health insurance sold by private insurance

companies to fill gaps in Original Medicare coverage (Part A and Part B)

• Medigap policies don’t work with any other type of health insurance, including Medicare Advantage Plans, employer/union group coverage, Veterans Administration (VA) benefits, or TRICARE

• Medigap policies help pay your share (coinsurance, copayments, or deductibles) of the costs of Medicare-covered services.

• Although some Medigap policies sold in the past cover prescription drugs, no new Medigap policies are allowed to include prescription drug coverage– If you want prescription drug coverage, you may want to join a Medicare

Prescription Drug Plan (PDP) offered by private companies approved by Medicare


You are Eligible for Medicare Part D if:• You are entitled to Medicare Part A and/or enrolled in Part B • You permanently reside in the service area of a Part D plan (a PDP

or MA-PD plan)


Initial Enrollment Period• Most people are first eligible for Medicare Part D when they turn 65• If you were eligible for Medicare prior to age 65 (such as for

disability), you will have another Initial Enrollment Period for Part D when you turn 65

• The Initial Enrollment Period (IEP) lasts for 7 months:– The IEP begins 3 months before the birthday month – The IEP continues during the birthday month– The IEP ends 3 months after the birthday month


Annual Open Enrollment Periods• Under normal circumstances after the Initial Enrollment Period, a

beneficiary only has the opportunity to enroll or change Part D plans during the Annual Coordinated Election Period (AEP) often called“Open Enrollment”– PDPs conduct Open Enrollment from November 15th through December 31st

– MA-PDs conduct Open Enrollment from January 1st through March 31st


Special Enrollment Periods• There are several situations that qualify an individual for a Special

Enrollment Period (SEP) outside of the normal Initial EnrollmentPeriod or Open Enrollment. Examples of these situations include:– Beneficiary moves outside his/her plan's region – Beneficiary gains/loses (voluntarily or involuntarily) employer coverage– Beneficiary is affected by plan’s CMS contract non-renewal or termination – Beneficiary disenrolls from the Program of All Inclusive Care for the Elderly

(PACE)– Beneficiary participates in both Medicare and Medicaid – Beneficiary is released from incarceration


Low Income Subsidy (LIS)• Medicare beneficiaries may be eligible for “extra help” if they have

limited income and resources. This program is known as Low Income Subsidy (LIS)

• LIS may pay:– All or part (25%, 50%, 75% or 100%) of the monthly premium not to exceed the

regional premium benchmark– All or part of the annual deductible – All or part of the co-pays/co-insurance

• CMS notifies the Plan Sponsor when a beneficiary is receiving this assistance

• The Plan Sponsor adjusts the beneficiary’s monthly premium bill accordingly, only billing the beneficiary for the difference (when applicable)

• CMS prospectively pays the Plan Sponsor the premium subsidy being paid on the beneficiary’s behalf


Low Income Cost Sharing Values for 2010

Source: CMS

LICS Level MBD Code in the

Adjudication System

Income Category

Deductible Initial Coverage

Limit

Coverage Gap

Catastrophic

I 2 ≤ 100% of the Federal Poverty Level (FPL) and

FBDE

$0 $1.10 generic$3.30 brand

$1.10 generic$3.30 brand

$0

II 1 <135%, or >100% FPL and

FBDE

$0 $2.50 generic$6.30 brand

$2.50 generic$6.30 brand

$0

III 4 <150% FPL $60 15% 15% $2.50 generic$6.30 brand

InstitutionalizedFull Benefit Dual Eligible

(FBDE)

3 Institutionalized FBDE

$0 $0 $0 $0


• You may qualify for extra help to pay for your prescription drugpremiums and costs

• To see if you qualify, call your state Medicaid office, Medicare or the Social Security Administration– Medicare

• 1-800-MEDICARE (1-800-633-4227)• TTY/TDD users: 1-877-486-2048• 24 hours a day, 7 days a week

– Social Security Administration• 1-800-772-1213• TTY/TDD users: 1-800-325-0778• Monday – Friday, 7 am to 7 pm

Extra Help


CMS Medicare Part D Benefit ParametersMedicare Part D Benefit Parameters for Defined Standard Benefit

2006 2007 2008 2009 2010$ Amount $ Amount $ Amount $ Amount % $ Amount %

Deductible $250 $265 $275 $295 7.2% $310 5.1%Initial Coverage Limit $2,250 $2,400 $2,510 $2,700 7.6% $2,830 4.8%

True Out-of-Pocket (OOP) Threshold $3,600 $3,850 $4,050 $4,350 7.4% $4,550 4.6%Total Covered Medicare Part D Drug Spend at OOP Threshold

$5,100.00 $5,451.25 $5,726.25 $6,153.75 7.5% $6,440 4.7%

Minimum Cost-Sharing in Catastrophic Coverage Portion of Benefit

Generic/Preferred Multi-Source Drug $2.00 $2.15 $2.25 $2.40 6.7% $2.50 4.2%Other $5.00 $5.35 $5.60 $6.00 7.1% $6.30 5.0%

Medicare Part D Benefit Parameters for Retiree Drug SubsidyCost Threshold $250 $265 $275 $295 7.2% $310 3.4%Cost Limit $5,000 $5,350 $5,600 $6,000 7.1% $6,300 5.0%

Source: CMS


True Out of Pocket (TrOOP) versus Total Drug Spend • True Out Of Pocket (TrOOP) and Total Drug Spend are two central

concepts to Medicare Part D. Both terms refer to measurement ofspending– True Out Of Pocket (TrOOP) – the amount of money that a beneficiary, or a

qualified third party on behalf of the beneficiary, spends on Part D drugs– Total Drug Spend – the total amount of money spent on a beneficiary’s Part D

drugs. This amount includes not only TrOOP, but also payments made by the Plan

• The relationship between TrOOP and Total Drug Spend is as follows:– TrOOP is a piece of the pie– Total Drug Spend is the whole pie


Determining True Out of Pocket (TrOOP) and Total Drug Spend Applies toward TrOOP• Front-end deductible if paid by

beneficiary or qualified third party

• Co-payments or co-insurance made by the beneficiary

• Co-payments or co-insurance made by a qualified third party on behalf of the beneficiary

• Low income subsidy amounts• Money spent out of pocket while

in the Coverage Gap if paid by beneficiary or qualified third party

Does not apply toward TrOOP• Premium payments• Payments made by group health

plans, insurers, government funded health programs, or similar third parties

• Money spent on drugs not covered by Medicare Part D (excluded drugs)


True Out of Pocket (TrOOP) versus Total Drug Spend – Basic Plan

Deductible

Initial Coverage Limit (ICL)

Coverage Gap

Catastrophic

There are 4 levels of

drug coverage:

The amount which the beneficiary must pay before there is any drug coverage by the plan sponsor

The beneficiary and plan sponsor both contribute to the drug cost

Also known as the “donut hole”. The beneficiary pays for all of the drug cost

The beneficiary pays only a very small amount of the drug cost. While the plan sponsor pays for a portion of the drug cost, the majority of the cost is paid for by Medicare Reinsurance.

Source: 2010 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies


True Out of Pocket (TrOOP) versus Total Drug Spend – Basic Plan

Deductible

Initial Coverage Limit (ICL)

Coverage Gap

Catastrophic

Tota

l Dru

g Sp

end

A beneficiary movesfrom one level ofcoverage to the nextbased on Total DrugSpend thresholds.

TrO

OP

A beneficiary enters the Catastrophiclevel (where most oftheir drug cost is paidfor them) based onTrOOP.

Source: 2010 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies


SilverScript Insurance Company Prescription Drug Plans


Vast Resources as a CVS Caremark Subsidiary• SilverScript Insurance Company is a subsidiary of CVS Caremark• CVS Caremark is one of the largest provider of prescriptions in the

nation• SilverScript Insurance Company provides Medicare Part D coverage

in all 50 states, D.C. and Puerto Rico• In 2009, SilverScript Insurance Company had over 1 million individual

lives enrolled in one of its prescription drug plans• SilverScript does not provide MA-PD products• The SilverScript pharmacy network includes over 64,000 pharmacies

across the country plus mail order pharmacy services


SilverScript Offers Three Plan DesignsPlan Name Positioning Statement

SilverScriptValue (PDP)

This plan offers prescription drug coverage at low-monthly premiums and is designed for Medicare-eligible beneficiaries who take a few prescription drugs but want peace of mind knowing their plan provides comprehensive coverage should their health needs change.

CVS CaremarkPlus (PDP)

Designed for Medicare-eligible beneficiaries who prefer brand-name drugs and a lower deductible. This product offers lower copays for some brands (Value Brand Tier) and many generics (Value Generic Tier) at preferred retail and mail pharmacies.

CVS CaremarkComplete (PDP)

Tailored to Medicare-eligible beneficiaries who prefer generics, no deductibles, and coverage in the donut hole. This plan also has lower copays for value tier generics at preferred retail and preferred mail pharmacies. To help beneficiaries with reducing their out-of-pocket costs, this Plan covers generics through the coverage gap with significantly lower copays available at preferred retail and mail pharmacies

Source: SilverScript Actuarial Services as of August 14, 2009


SilverScript 2010 Prescription Drug PlansRegions 1 – 34, 38 SilverScript Value CVS Caremark Plus CVS Caremark Complete

Premium Range $7.90 - $50.80 $17.50 - $68.90 $39.40 - $90.70Deductible $310 $50 NoneFormulary Copays in ICL

Value Generic Tier (VGT)*Generic TierValue Brand Tier (VBT)*Preferred Brand TierNon-Preferred Brand TierSpecialty Tier **

Retailn/a

$7 - $8n/a

$15 - $28$70 - $95

25%

Mailn/a

$12.25 - $14n/a

$37.50 -$70$192.50 - $261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a

Coverage Gap Copays no coverage no coverage no coverage no coverage

PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic

Non-Preferred Retail

Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic

* At Preferred Pharmacies, Value Generic Tier and Value Brand Tier copays are as shown; At Non-Preferred Pharmacies, Value Generic Tier and Value Brand Tier copays are not available.

** Specialty Tier drugs include biologics and other high-priced generics and brand drugs



SilverScript Prescription Drug Plan Formularies


SilverScript 2010 Open PDP Formularies • SilverScript Value

– 4-tier formulary– Over 3,100 drugs

• CVS Caremark Plus– 6-tier formulary– Low cost generic value tier

• Part of the CVS Caremark Plus and CVS Caremark Complete plan designs• Includes 175 low cost generic drugs

– Therapeutic class-specific value brand tier• Part of the CVS Caremark Plus plan design• Includes 83 brand name drugs from the following 5 classes: Anti-Coagulants, Anti-

Hypertensives, Estrogens, Ophthalmic Agents and Thyroid Agents

• CVS Caremark Complete – 5-tier formulary– Low cost generic value tier (see above)



SilverScript Value 2010 4-Tier Formulary

SpecialtyTier185

Non-Preferred BrandsTier222

PreferredBrandsTier853

GenericsTier1,878

SilverScript Value 2010 open PDP formulary contains 3,138 drugs



SilverScript Complete 2010 5-Tier Formulary

SpecialtyTier185



GenericsTier1,703

Value GenericsTier175

CVS Caremark Plus 2010 open PDP formulary contains 3,171 drugs

Total Generics = 1,878



SilverScript Plus 2010 6-Tier Formulary

SpecialtyTier185



Value Brands Tier83

GenericsTier1,703

Value GenericsTier175

CVS Caremark Plus 2010 open PDP formulary contains 3,171 drugs

Total Preferred Brands = 853

Total Generics = 1,878



Part D Excluded Drugs• Certain drugs, classes of drugs, or their medical uses are excluded by law from Part D

coverage. The following drugs or drug uses are excluded from Medicare Part D:– Fertility drugs– Weight loss/gain drugs– Non-prescription drugs– Prescription vitamins and minerals (except prenatal vitamins and fluoride preparation)– Cosmetic or hair growth drugs– Benzodiazepines and Barbiturates – Cough and cold symptom relief drugs– Sexual and Erectile Dysfunction drugs (except when used for other FDA approved use such as

pulmonary hypertension)– Drugs for which the manufacturer seeks to require as a condition of purchase that associated tests &

monitoring services be purchased exclusively from the manufacturer or its designee• DESI 5 and DESI 6 drugs (drugs which are safe, but deemed less than effective by the

FDA’s Drug Efficacy Study Implementation) are excluded from Medicare Part D.• Any amount that a beneficiary spends on excluded drugs does not count towards TrOOP• SilverScript does not cover any Part D excluded drugs


SilverScript Pharmacy Networks• The SilverScript pharmacy network includes over 64,000 in network pharmacies

across the country• In-network pharmacies may be preferred or non-preferred. Beneficiaries may go to

either preferred or non-preferred pharmacies to receive covered prescription drugs• Preferred pharmacies include CVS/pharmacy, Longs Drugs, and Caremark mail

service pharmacies • In the CVS Caremark Plus and CVS Caremark Complete plans members have

access to lower cost sharing for value tier drugs at preferred pharmacies than at non-preferred pharmacies.

• Cost sharing is always lower at in-network than at out-of-network pharmacies• If there is not a preferred retail pharmacy near your home, you can visit

www.cvs.com or www.longs.com to save online or use Caremark mail service where your medications and savings will be delivered directly to your door

Source: CVS Caremark Network Management as of May 19, 2009


ExtraCare® Health Card• The ExtraCare Health card is a value-added service provided for free

to all SilverScript Insurance Company members• It is not part of the Part D plan benefit • 20% discount on FSA-eligible, CVS

Brand products– Applies to more than 1,500 items at 6,300 stores– Helps participants access over-the-counter (OTC) remedies at lower costs

• Discount is available at CVS/pharmacy locations and cvs.com


Examples of Some of the Items Eligible for the ExtraCare® Health Discount• Allergy Remedies

– Decongestant, Allergy Relief, Loratidine (compare to Claritin®), Cetirizine (compare to Zyrtec®)• Pain Relievers

– Acetaminophe, Aspirin, Children’s Aspirin, Migraine Relief, Ibuprofen, Naproxen• Home Diagnostics

– Alcohol Preps, Glucose Test Strips, Gauze Pads, Needles, Auto-Injectors, Blood Pressure Cuff, Glucose Meter, Lancets, Glucose Tablets, Pedometer

• Eye and Ear Care– Contact Lens Solution, Eye Drops, Pink Eye Relief, Ear Wax Remover, Ear Plugs

• Stomach Remedies – Antacid, Acid Reducer, Fiber Supplements, Laxatives, Motion Sickness Relief, Pink Bismuth

• Oral Hygiene – Anti-Plaque Mouthwash, Oral Anesthetic, Dry Mouth Relief, Cold Sore Treatment

• Cough and Cold – Cough Suppressant, Cough Drops, Anti-Bacterial Wipes, Cold and Flu Relief, Cold and Sinus Relief, Children’s

Cold and Allergy Elixir, Decongestant, Digital Thermometer, Nasal Spray, Lozenges• First Aid

– Rubbing Alcohol, Adhesive Strips, Dressings, Anti-Bacterial Ointment, Hydrocortisone Cream, Burn Relief, Cotton Gauze, Hand Sanitizer, Hot and Cold Packs, Peroxide, Pain Relieving Patches

• Nicotine Replacements– Nicotine Gum, Nicotine Patches

NOTES: This list is not all inclusive and is subject to change. Please note that vitamins and supplements are not FSA-eligible and are therefore not eligible for the discount.


Questions and Answers!


• SilverScript Insurance Company is a subsidiary of CVS Caremark, and is contracted with the federal government to provide Medicare prescription drug plans to Medicare beneficiaries in all 50 states and Puerto Rico

• This plan sponsor contracts with the federal government and is available to anyone entitled to Medicare Part A or enrolled in Part B. If you are enrolled in a Medicare Advantage HMO or PPO plan or aprivate fee-for-service plan that includes Medicare prescription drug plan you may not enroll in a SilverScript PDP unless you first end your participation in the HMO, PPO, or MA PFFS plan. If your plan provides neither Medicare prescription drug coverage nor an MA Medical Savings Account (MSA), you may enroll in a PDP.

About SilverScript


SilverScript Region-Specific Plan Design Charts


SilverScript 2010 Prescription Drug PlanRegion 1 – ME, NH

Region 1 SilverScript Value CVS Caremark Plus CVS Caremark CompletePremium Range $34.20 $45.10 $64.20Deductible $310 $50 NoneFormulary Copays


Retailn/a$8n/a$28$9525%

Mailn/a$14n/a$70

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 2 – CT, MA, RI, VT



Retailn/a$8n/a

$26.50$9525%

Mailn/a$14n/a

$66.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 3 - NY



Retailn/a$8n/a

$23.50$9525%

Mailn/a$14n/a

$58.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 4 - NJ



Retailn/a$8n/a

$22.50$9525%

Mailn/a$14n/a

$56.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 5 – DE, DC, MD




Mailn/a$14n/a$70

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 6 – PA, WV




Mailn/a$14n/a

$52.50$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 7 - VA




Mailn/a

$12.25n/a$55

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 8 - NC




Mailn/a$14n/a$50

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 9 - SC



Retailn/a$7n/a

$21.25$9525%

Mailn/a

$12.25n/a

$53.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 10 - GA



Retailn/a$8n/a

$20.50$9525%

Mailn/a$14n/a

$51.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 11 - FL



Retailn/a$8n/a

$25.50$9525%

Mailn/a$14n/a

$63.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 12 – AL, TN



Retailn/a$7n/a

$19.75$9525%

Mailn/a

$12.25n/a

$49.50$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 13 - MI



Retailn/a$8n/a

$27.25$9525%

Mailn/a$14n/a

$68.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 14 - OH



Retailn/a$8n/a

$23.50$9525%

Mailn/a$14n/a

$58.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 15 – IN, KY



Retailn/a$8n/a

$22.50$9525%

Mailn/a$14n/a

$56.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 16 - WI



Retailn/a$8n/a

$21.25$9525%

Mailn/a$14n/a

$53.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 17 - IL




Mailn/a$14n/a$50

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 18 - MO




Mailn/a$14n/a$50

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 19 - AR




Mailn/a

$12.25n/a$45

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 20 - MS



Retailn/a$7n/a

$17.75$9525%

Mailn/a

$12.25n/a

$44.50$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 21 - LA



Retailn/a$7n/a

$19.25$9525%

Mailn/a

$12.25n/a

$48.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 22 - TX



Retailn/a$8n/a

$22.50$9525%

Mailn/a$14n/a

$56.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 23 - OK



Retailn/a$8n/a

$24.25$9525%

Mailn/a$14n/a

$60.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 24 - KS



Retailn/a$8n/a

$21.50$9525%

Mailn/a$14n/a

$53.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 25 – IA, MN, MT, ND, NE, SD, WY



Retailn/a$8n/a

$21.50$9525%

Mailn/a$14n/a

$53.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 26 - NM




Mailn/a$14n/a

$52.50$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 27 - CO



Retailn/a$8n/a

$24.50$9525%

Mailn/a$14n/a

$61.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 28 - AZ



Retailn/a$7n/a

$19.50$9525%

Mailn/a

$12.25n/a

$48.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 29 - NV



Retailn/a$8n/a

$23.75$9525%

Mailn/a$14n/a

$59.50$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 30 – OR, WA



Retailn/a$8n/a

$22.25$9525%

Mailn/a$14n/a

$55.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 31 – ID, UT



Retailn/a$8n/a

$25.25$9525%

Mailn/a$14n/a

$63.25$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 32 - CA




Mailn/a$14n/a$65

$261.25n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 33 - HI




Mailn/a

$12.25n/a

$47.50$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 34 - AK



Retailn/a$7n/a

$16.25$9525%

Mailn/a

$12.25n/a

$40.75$261.25

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic





SilverScript 2010 Prescription Drug PlanRegion 38 - PR




Mailn/a

$12.25n/a

$37.50$192.50

n/a

Retail$2.50$7.50$25$30$9031%

Mail$5

$14$63$75

$248n/a

Retail$2.50$7.50

n/a$39$9833%

Mail$5

$19n/a$98

$270n/a


PreferredRetail

Pharmacies$2.50 VGT

$7.50 Generic


Pharmacies$39 VGT

$39 Generic

PreferredMail

Pharmacies$5 VGT

$19 Generic




Date post:	06-Feb-2018
Category:	Documents
Upload:	hoangthuy
View:	216 times
Download:	0 times

SilverScript Insurance Company Medicare Prescription · PDF fileSilverScript Insurance Company...

Documents