Aetna by Silverscript Medicare Part D plan
Classic Plus Formulary
Deductible - $615 – applies to drugs in tier 3-5, deductible does not apply to Tier 1 and 2 drugs
THIS IS MOST IMPORTANT FACT:
Maximum out of Pocket (MOOP) - $2,100 - the deductible, copays and coinsurance apply towards the MOOP. Once the MOOP is reached, your out of pocket expenses will be reduced to $0 for covered prescription drugs.
- You won’t pay more than $35 for a one-month supply or $105 for three-month supply of each covered insulin product regardless of cost sharing tier.
- Prior Authorization (PA) and Step Therapy (ST) applies. Please refer to the formulary for more information on what drugs require PA or ST and list of covered drugs for the Classic + Formulary.
- Subject to Medicare rules and regulations
- Each retiree is enrolled individually and will receive their own ID card.
- Each retiree must meet their own deductible and MOOP (Maximum Out OF Pocket).
