FAIL result1 Rocky Mountain Green Plan + Rx (Cost) H0602-043-30 days-Initial Coverage Drugs=S

2015 Rocky Mountain Green Plan + Rx (Cost) Drug Coverage Details

Below is the Formulary, or drug list, for Rocky Mountain Green Plan + Rx (Cost) from Rocky Mountain Health Maintenance Organization This formulary is a list of prescription medications that are covered under Rocky Mountain Health Maintenance Organization's 2015 Medicare Advantage Plan. The Rocky Mountain Green Plan + Rx (Cost) plan has a $110 drug deductible. This deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. However some drugs do not require that the deductible is met before you receive coverage. You can see if the deductible is required below in the "Does the Deductible Apply" column. The Initial Coverage Limit (ICL) for this plan is $2960. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $2960 on covered drugs. (combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" be clicking the "Coverage Gap" link on the left above the chart. In 2015 if you have spent $4700 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Rocky Mountain Green Plan + Rx (Cost) will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link on the left above the chart.

Plan Name:
Rocky Mountain Green Plan + Rx (Cost)
Plan ID:
Provider: Rocky Mountain Health Maintenance Organization
Plan Year:2015
Initial Coverage Limit:$2960
Coverage Area:Colorado

Current Table info:

Coverage level : Initial Coverage
Days Supply : 30 Days
Drugs Starting With Letter: S

Change Table Options:

Drugs Starting Letter:
A  B  C  D  E  F  G  H  I  J  K  L  M 
N  O  P  Q  R  S  T  U  V  W  X  Y  Z 

Coverage Level:
Pre-deductible,Initial Coverage
Coverage Gap, Catastrophic

Drug Days Pricing:
30 Day Supply, 60 Day Supply, 90 Day Supply

(Mouse over for Tips)
(Click the Drug Name to Compare every Plans Price)

Drug Name Drug Strength Units in Package Tier Level Amount Limit Days Limit Prior Authorization Y/N Step Therapy Y/N Does the Deduct Apply Cost Prefered Max Cost Pref Cost Non Pref Max Cost Non Pref Cost Amt Mail Max Cost Mail


Please Select a different Coverage Option:
Initial Coverage
Coverage Gap

30 Day Supply
60 Day Supply
90 Day Supply

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