The SilverScript Employer PDP sponsored by Temple University 2019 Benefit Summary:

Monthly Premium, Deductible, and Limits on How Much You Pay for Covered Services
Premium Please contact Temple University 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 $3,820. 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
10% of total cost
10% of total cost
Tier 2 - Preferred Brands
20% of total cost
20% of total cost
Tier 3 - Non-Preferred Brands
30% of total cost
30% of total cost
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
7.5% of total cost
10% of total cost
7.5% of total cost
Tier 2 - Preferred Brands
15% of total cost
20% of total cost
15% of total cost
Tier 3 - Non-Preferred Brands
23% of total cost
30% of total cost
23% of total cost

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 (1-90 days).
Coverage Gap The coverage gap (also called the “donut hole”) begins after the total yearly drug costs (including what the plan has paid and what you have paid) reaches $3,820.

Due to the additional coverage provided by Temple University, 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 $5,100, you pay the greater of:

  • 5% of the cost, or
  • $3.40 copayment for generics (or a drug that is treated like a generic) and an $8.50 copayment for all other drugs.

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