| Benefit Parameters |
2011 |
2012 |
| Deductible |
$310.00 |
$320.00 |
| Initial Coverage Limit |
$2,840.00 |
$2,930.00 |
| Out-of-Pocket Threshold |
$4,550.00 |
$4,700.00 |
| Total Covered Drug Spend at OOP Threshold |
$6,447.50 |
$6,657.50
plus a 50%
brand discount |
Minimum Cost-Sharing in
Catastrophic Coverage |
$2.50/$6.30 |
$2.60/$6.50** |
| LIS Co-payments |
2011 |
2012 |
| Institutionalized |
$0 |
$0 |
| Up to or at 100% FPL |
$1.10/$3.30 |
$1.10/$3.30 |
| Other LIS |
$2.50/$6.30 |
$2.60/$6.50 |
| Partial LIS Deductible/Cost-Sharing |
$63/15% |
$65/15% |
** The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2012, beneficiaries would be charged $2.60 for those generic or preferred multisource drugs with a retail price under $52 and 5% for those with a retail price greater than $52. As to Brand drugs, beneficiaries would pay $6.50 for those drugs with a retail price under $130 and 5% for those with a retail price over $130.
