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Part D Prescription Drug Plans (PDP)

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ZIP CODE

View 2022 plans

	SilverScript SmartRx (PDP)	SilverScript Choice (PDP)	SilverScript Plus (PDP)
Average Monthly Premium	$7.08	$30.78*	$68.97
Deductible**	Tier 1: $0	Tier 1 / Tier 2: $0	$0 on all tiers
Tier 1 copay^†	$1	$0	$0
Tier 2 copay^†	$19	$5^††	$2
Cost of 90-day supply of prescription medication^§	Tier 1: $3	Tier 1: $0	Tier 1 / Tier 2: $0^§§
Additional gap coverage	No	No	Tier 1 / Tier 2

SilverScript SmartRx (PDP)
Average Monthly Premium	$7.08
Deductible**	Tier 1: $0
Tier 1 copay^†	$1
Tier 2 copay^†	$19
Cost of 90-day supply of prescription medication^§	Tier 1: $3
Additional gap coverage	No

SilverScript Choice (PDP)
Average Monthly Premium	$30.78*
Deductible**	Tier 1 / Tier 2: $0
Tier 1 copay^†	$0
Tier 2 copay^†	$5^††
Cost of 90-day supply of prescription medication^§	Tier 1: $0
Additional gap coverage	No

SilverScript Plus (PDP)
Average Monthly Premium	$68.97
Deductible**	$0 on all tiers
Tier 1 copay^†	$0
Tier 2 copay^†	$2
Cost of 90-day supply of prescription medication^§	Tier 1 / Tier 2: $0^§§
Additional gap coverage	Tier 1 / Tier 2

*As low as $0 if you receive Extra Help.

**For SmartRx Tier 2-5 drugs, and Choice Tier 3-5 drugs, the deductible is $480.

^†For 30-day supply, at preferred pharmacies in the initial coverage stage.

^††Copays may vary by state.

^§Free standard mail delivery or pickup at a preferred retail pharmacy.

^§§Pay a $0 copay for Tier 1 and Tier 2 drugs for up to a 90-day supply, at a preferred pharmacy.

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