The SilverScript Employer PDP sponsored by REHP PEBTF 2025 Benefit Summary:
| Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services |
| Premium |
Please contact the PEBTF for more information about the premium for this plan.
|
| Deductible |
This plan does not have a deductible.
|
| Initial Coverage |
During the Initial Coverage Stage, you pay a portion of your drug costs, and the plan pays its portion. The following tables show what you pay until your out-of-pocket covered Part D drug costs reach $2,000. Total yearly drug costs are the total drug costs paid by both you and SilverScript. You may get your drugs at network retail pharmacies or through the mail-order pharmacy.
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Your share of the cost when you get a 30-day supply of a covered Part D prescription drug:
|
|
Network Retail Pharmacy
(Up to a 30-day supply available at any network pharmacy)
|
Mail-Order
Pharmacy
(Up to a 30-day supply)
|
Long-Term Care (LTC) Pharmacy
(Up to a 31-day supply)
|
Tier 1 - Generic/Preferred Generic
|
$12.00
|
$12.00
|
$12.00
|
Tier 2 - Preferred Brand
|
$30.00 *
|
$30.00 *
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$30.00 *
|
Tier 3 - Non-Preferred Brand
|
$60.00 *
|
$60.00 *
|
$60.00 *
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Your share of the cost when you get a long-term supply (up to 90 days) of a covered Part D prescription drug:
|
|
Preferred Network
Retail Pharmacy
(Up to a 90-day supply)
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Standard Network
Retail Pharmacy
(Up to a 90-day supply)
|
Mail-Order
Pharmacy
(Up to a 90-day supply)
|
Tier 1 - Generic/Preferred Generic
|
$18.00
|
$24.00
|
$18.00
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Tier 2 - Preferred Brand
|
$45.00 *
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$60.00 *
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$45.00 *
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Tier 3 - Non-Preferred Brand
|
$90.00 *
|
$120.00 *
|
$90.00 *
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| Catastrophic Coverage |
During this payment stage, you pay nothing for your covered Part D drugs.
- For excluded drugs covered under the additional coverage provided by REHP, you’ll continue to
pay the same cost sharing amount during the Catastrophic Coverage stage. To find out the cost
of your drug, use our online drug pricing tool within Caremark.com or call Customer Care at the
number on your ID card.
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You won’t pay more than $35 for a one-month supply of each covered insulin product regardless of the cost-sharing tier.
*Plus the cost difference between brand and generic, if one exists.
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