The SilverScript Employer PDP sponsored by Frederick Schools 2021 Benefit Summary:

Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services
Premium Please contact Frederick County Public Schools 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 total yearly drug costs reach $4,130. 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.
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)
Long-Term Care (LTC) Pharmacy
(Up to a 31-day supply)
Tier 1 - Generics
$13.00
$13.00
Tier 2 - Preferred Brands
$25.00
$25.00
Tier 3 - Non-Preferred Brands
$40.00
$40.00
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)
Non-Preferred Network
Retail Pharmacy
(Up to a 90-day supply)
Mail-Order
Pharmacy
(Up to a 90-day supply)
Tier 1 - Generics
$21.00
$39.00
$21.00
Tier 2 - Preferred Brands
$45.00
$75.00
$45.00
Tier 3 - Non-Preferred Brands
$65.00
$120.00
$65.00

Note: You pay the same share of the cost for your drug filled through the Mail-Order Pharmacy, whether you get a one-month supply or a long-term supply. This means that the copayment or coinsurance listed above is applicable for any order, regardless of the day supply.
Coverage Gap The coverage gap begins after the total yearly drug costs (including what the plan has paid and what you have paid) reaches $4,130.

Due to the additional coverage provided by Frederick County Public Schools, you have the same copayments or coinsurance that you had during the Initial Coverage Stage. Therefore, you may see no change in your copayment and/or coinsurance until you qualify for catastrophic coverage.
Catastrophic Coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,550, you pay the following for your drugs and the plan will pay the rest:

  • Generics (or a drug that is treated like a generic) 
  • For up to a 30-day supply, you pay a $3.70 copayment or 5% of the drug cost, whichever is greater, but no more than $13.00.
  • Preferred Brands 
  • For up to a 30-day supply, you pay an $9.20 copayment or 5% of the drug cost, whichever is greater, but no more than $25.00.
  • Non-Preferred Brands 
  • For up to a 30-day supply, you pay an $9.20 copayment or 5% of the drug cost, whichever is greater, but no more than $40.00.

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