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AmeriHealth Rx Option I PDP
AmeriHealth Rx Option I PDP is a prescription drug plan with a Medicare contract and is offered by QCC Insurance Company. AmeriHealth Rx Option I PDP is administered by FutureScripts® Secure, a pharmacy benefit management program, and is available throughout Pennsylvania and West Virginia.
AmeriHealth Rx Option I PDP Monthly Premium: $65.50
AmeriHealth Rx Option I PDP provides the standard Medicare Part D prescription drug benefit (with $310 annual deductible; 25% coinsurance from $311 to $2,830 in total yearly costs). After the member’s yearly true out-of-pocket (TrOOP) costs reach $4,550, AmeriHealth Rx Option I PDP members will pay the greater of 5% coinsurance or $2.50 generic and $6.30 brand copayment for the rest of the year.
| AmeriHealth Rx Option I PDP |  |
| Monthly premium | $65.50 |
| Deductible (what you pay before the plan starts to pay) | $310 |
| Initial Coverage Phase (what you and the plan pay in total covered prescription drug costs up to a certain level — the Initial Coverage limit) | $311 to $2,830 in total yearly costs. |
| Coverage Gap (when you pay all drug costs until the catastrophic coverage begins) | You pay 100% of the cost of drugs until your true out-of-pocket (TrOOP) costs reach $4,550. |
| Catastrophic Coverage (starts after you have paid $4,550 out of pocket for covered drugs in a year) | You pay greater 5% coinsurance or a $2.50 copay for generic (preferred or non-preferred) drugs and a $6.30 copay for all other drugs. |
Enroll by mail
Download 
AmeriHealth Rx Option I PDP Form.
Mail to:
AmeriHealth 65
Medicare Department
P O Box 7576
Philadelphia, PA 19101-8951
Summary of Benefits
The Summary of Benefits tells you about some of the plan’s features. You should refer to the Summary of Benefits for:
- applicable conditions and limitations;
- premiums;
- cost-sharing (e.g., copayments, coinsurance, and deductibles);
- any conditions associated with receipt or use of benefits.
Download the AmeriHealth Rx Option I PDP Summary of Benefits.
Evidence of Coverage
The Evidence of Coverage is our contract with you. It explains your rights, benefits, and responsibilities as a member of our plan.
Download the AmeriHealth Rx Option I PDP Evidence of Coverage.
Drug Formulary
A drug formulary is a list of generic and brand-name prescription drugs that are covered by the plan, are FDA-approved, and have been chosen for their reported medical effectiveness and value.
Download the AmeriHealth Rx Option I PDP Formulary.
Contact us
For more information, please contact us.
Read some of the most frequently asked questions about the AmeriHealth Rx Option I PDP .
