The Vital Traditions Rx Plan is part of your Vital Traditions coverage. The Rx Plan Includes:
- Thousands of in-network pharmacies across Texas.
- Convenient home delivery mail order service
- 90-day supply of maintenance drugs, available for two co-payments
- Access to a complete range of generic and brand-name drugs.
| |
Value Rx |
| Monthly Premium |
$0 |
| Initial Coverage Amount |
$2,960 |
| Deductible |
$0 |
| Out-of-Pocket Maximum |
$4,700 |
| Co-Pays during Initial Coverage Period |
| Tier 1 - Preferred Generic Drugs |
$2 |
| Tier 2 - Non-Preferred Generic Drugs |
$15 |
| Tier 3 - Preferred Brand Drugs |
$45 |
| Tier 4 - Non-Preferred Brand Drugs |
$85 |
| Tier 5 - Specialty Drugs |
33% |
| After Initial Coverage Amount You Pay |
| Generic Drugs |
65% |
| Brand Drugs |
45% |
| All Other Drugs |
100% |
| Total Out-of-Pocket You Pay before Catastrophic Coverage |
$4,700 |
Catastrophic Coverage Amounts you pay the greater of:
Generic Drugs (including brand drugs treated as generic)
All Other Drugs
|
5% or
$2.65
$6.60 |
The SeniorCare (Cost) Medicare Part D prescription plans are optional and available only to SeniorCare plan members. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Members must use network pharmacies to access their prescription drug benefit except under non-routine circumstances, and quantity limitations and restrictions may apply. Our network of pharmacies has both preferred and other network pharmacies. You can fill prescriptions at either.