Page 96 - Appendices to Jane Miller's evaluation

Brand-name drugs:
$9.20 copay or 5% (whichever costs
Initial coverage Gap coverage
Tiers Catastrophic coverage phase
more)
phase phase 1
Generic $0.00 copay $0.00 copay

Preferred Brand $47.00 copay

Non-Preferred
$100.00 copay
Drug

Specialty Tier 29%

1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

PART B DRUGS

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Limits apply

Other Part B drugs
In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Limits apply

Star ratings

OVERALL STAR RATING

HEALTH PLAN STAR RATINGS

DRUG PLAN (PART D) STAR RATING