AmeriHealth Rx Option II PDP

AmeriHealth Rx Option II PDP is a prescription drug plan with a Medicare contract and is offered by QCC Insurance Company. AmeriHealth Rx Option II PDP is administered by FutureScripts^® Secure, a pharmacy benefit management program, and is available throughout Pennsylvania and West Virginia.

AmeriHealth Rx Option II PDP Monthly Premium: $66.70

AmeriHealth Rx Option II PDP provides a Medicare Part D prescription drug benefit that includes a $100 deductible, preferred and non-preferred generic and brand copays, as well as a specialty coinsurance. After you meet your $100 deductible, you pay the following until your drug costs reach $2,830:

• $7 preferred generic copay
• $15 non-preferred generic copay
• $35 brand preferred copay
• $70 non-preferred brand copay
• 30% for specialty drugs

After the total cost of drugs paid by you, the plan and/or others making payment on your behalf reach $2,830, you pay 100% of drug cost of brand drugs and wil pay the preferred or non-preferred generic copays through the Coverage Gap.

After the total cost of drugs paid by you, the plan and/or others making payment on your behalf reach $4,550, you pay the greater of 5% coinsurance or a $2.50 copay for generic (preferred or non-preferred) drugs and a $6.30 copay for all other drugs thereafter.

AmeriHealth Rx Option II PDP
Monthly premium	$66.70
Deductible (what you pay before the plan starts to pay)	$100
Initial Coverage Phase (what you and the plan pay in total covered prescription drug costs up to a certain level — the Initial Coverage limit)	For the first $2,830 in total drug costs, you pay $7 per preferred generic, $15 per non-preferred generic, $35 per preferred brand and $70 per non-preferred brand, and 30% for specialty drugs on the formulary.
Coverage Gap (when you pay all drug costs until the catastrophic coverage begins)	Preferred and non-preferred generic copay through the coverage gap.
Catastrophic Coverage (starts after you have paid $4,550 out of pocket for covered drugs in a year)	You pay the greater of 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 II 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 II 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 II 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 II PDP Formulary.

Contact us

For more information, please contact us.

Read some of the most frequently asked questions about the AmeriHealth Rx Option II PDP.