Rx Formulary for MedicareRx Gold.

Monthly cost $35.29.

There are four 'tiers' which relate to your copay to get the prescription. Tier 1 is $10, Tier 2 is $30, Tier 3 is $60, Tier 4 is 30%.

Call 800-655-9525 Fax completed applications to 1-866-303-9525.
:: Critical Dates ::.

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