2015 Rocky Mountain Standard Plan + Rx (Cost) Drug Coverage Details
Below is the Formulary, or drug list, for Rocky Mountain Standard 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 Standard Plan + Rx (Cost) plan has a $0 drug deductible. 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 Standard 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 Standard Plan + Rx (Cost) |
|---|---|
| Plan ID: | H0602-017 |
| Provider: | Rocky Mountain Health Maintenance Organization |
| Plan Year: | 2015 |
| Premium: | $62.50 |
| Deductible: | $0 |
| 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:
Initial Coverage
Coverage Gap,
Catastrophic
Drug Days Pricing:
30 Day Supply,
60 Day Supply,
90 Day Supply
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(Click the Drug Name to Compare every Plans Price)