Coverage Stages — How Much Do You Pay?
Determine how much the drug will cost based on your coverage stage.
Stage 1: Initial Coverage Stage
The cost of your drugs is split between you and the plan. You stay in this stage until your payments for the year plus the plan’s payments total $4,130.
Stage 2: Coverage Gap Stage/Donut Hole
You pay 25 percent of the plan’s cost for covered brand name drugs and 25 percent of the plan’s cost for covered generic drugs until your costs total $6,550, unless you are already getting Medicare Extra Help. The Prominence Plus Plan provides Tier 1, 2 and 6 drugs during the Coverage Gap/Donut Hole.
Stage 3: Catastrophic Coverage Stage
Once you have paid enough for your drugs to move into this last payment stage, the plan will pay most of the cost of your drugs for the rest of the year.*
* You pay the greater of 5 percent or $3.70 for generic or preferred multi-source drugs and the greater of 5 percent or $9.20 for all other drugs.
NOTE: Eligible beneficiaries must use network pharmacies to access prescription drug benefits, except in nonroutine circumstances. Quantity limits and restrictions may apply.