*Plus you must continue to pay Medicare Part B Premium

• $115 deductible - applies to brand drugs only

• $6 copay generic
  $33 copay preferred brand
  $53 copay non preferred brand
  Until you reach $2,510 in retail drug expenses

• After $2,510 in retail drug expenses you pay 100% of costs until you reach $4,050 out-of-pocket drug costs

• You pay $2.25 generic and $5.60 for all other drugs or 5% of cost (whichever is greater) after $4,050 in out-of-pocket drug costs