Page 87 - APPENDICES for Diane Falten

Initial coverage Gap coverage Catastrophic coverage
phase phase phase

Generic drugs:
Generic drugs:

$3.95 copay or 5% (whichever
Specialty Tier 25%
costs more)

28% Brand-name Brand-name drugs:
drugs: $9.85 copay or 5% (whichever
25%
costs more)