Stage 2017 (this year) 2018 (next year) Stage 2: Initial Coverage Stage Your cost for a one-month Your cost for a one-month supply filled at a network supply filled at a network Once you pay the yearly pharmacy with standard pharmacy with standard deductible, you move to the cost-sharing: cost-sharing: Initial Coverage Stage. During this stage, the plan pays its share Tier 1: Tier 1: of the cost of your drugs and you You pay 25% of the total You pay 25% of the total pay your share of the cost. cost. cost. The costs in this row are for a Once your total drug costs Once your total drug costs one-month (30 day) supply when have reached $3,700, you have reached $3,750, you you fill your prescription at a will move to the next will move to the next network pharmacy that provides stage (the Coverage Gap stage (the Coverage Gap standard cost-sharing. For Stage). Stage). information about the costs for a long-term supply; or for prescriptions, look in Chapter 6, Section 5 of your Evidence of Coverage. Changes to the Coverage Gap and Catastrophic Coverage Stages The other two drug coverage stages the Coverage Gap Stage and the Catastrophic Coverage – Stage are for people with high drug costs. Most members do not reach the Coverage Gap – Stage or the Catastrophic Coverage Stage. For information about your costs in these stages, look at Chapter 6, Sections 6 and 7, in your Evidence of Coverage.
Stage 2017 (this year) 2018 (next year) Stage 2: Initial Coverage Stage Once you pay the yearly deductible, you move to the Initial Coverage Stage. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. The costs in this row are for a one-month (30 day) supply when you fill your prescription at a network pharmacy that provides standard cost-sharing. For information about the costs for a long-term supply; or for prescriptions, look in Chapter 6, Section 5 of your Evidence of Coverage. Your cost for a one-month supply filled at a network pharmacy with standard cost-sharing: Tier 1: You pay 25% of the total cost. Once your total drug costs have reached $3,700, you will move to the next stage (the Coverage Gap Stage). Your cost for a one-month supply filled at a network pharmacy with standard cost-sharing: Tier 1: You pay 25% of the total cost. Once your total drug costs have reached $3,750, you will move to the next stage (the Coverage Gap Stage). Changes to the Coverage Gap and Catastrophic Coverage Stages The other two drug coverage stages – the Coverage Gap Stage and the Catastrophic Coverage Stage – are for people with high drug costs. Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage. For information about your costs in these stages, look at Chapter 6, Sections 6 and 7, in your Evidence of Coverage.
H4093_ISNP_HMO_NONPOS_Model_wRx_v2-PA_EOC.docx