The SilverScript Employer PDP sponsored by California's Valued Trust 2025 Benefit Summary:
| Monthly Premium and Limits on How Much You Pay for Covered Services |
| Premium |
Please contact California’s Valued Trust (CVT) for more information about the premium for this plan.
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| Deductible |
This plan does not have a deductible.
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| Initial Coverage |
You pay the amounts in the tables below until your total yearly drug costs reach $2,000. Total yearly drug costs are the amounts paid by both you and the plan for Part D drugs. You may get your drugs at network retail pharmacies and mail order pharmacies. Some of our network pharmacies are preferred network retail pharmacies where you pay the same cost as mail order for a 90-day supply of a non-specialty maintenance medication.
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Your share of the cost when you get a 30-day supply of a covered Part D prescription drug:
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Network Retail Pharmacy
(Up to a 30-day supply available at any network pharmacy)
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Long-Term Care (LTC) Pharmacy
(Up to a 31-day supply)
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Tier 1 - Generics
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$0.00
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$0.00
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Tier 2 - Preferred Brands
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$0.00
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$0.00
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Tier 3 - Non-Preferred Brands
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$0.00
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$0.00
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Tier 4 - High Cost/Specialty
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$0.00
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$0.00
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Your share of the cost when you get a long-term supply (up to 90 days) of a covered Part D prescription drug:
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Preferred Network Retail Pharmacy
(Up to a 90-day supply)
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Standard Network Retail Pharmacy
(Up to a 90-day supply)
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Mail-Order Pharmacy
(Up to a 90-day supply)
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Tier 1 - Generics
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$0.00
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$0.00
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$0.00
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Tier 2 - Preferred Brands
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$0.00
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$0.00
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$0.00
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Tier 3 - Non-Preferred Brands
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$0.00
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$0.00
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$0.00
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Tier 4 - High Cost/Specialty
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N/A
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N/A
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N/A
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| Catastrophic Coverage |
After you reach $2,000 in Medicare out-of-pocket costs for the year, you are in the Catastrophic Coverage stage.
During the Catastrophic Coverage stage, you continue to have $0 copayment for covered drugs.
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