First United American Prescription Drug Plans (PDP)

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	First United American Select (PDP)	First United American Preferred (PDP)
Overview	Offers the lower premium of our two plans $320 annual deductible You pay nothing for Preferred Generics through our mail order Low copays for Preferred Generic drugs purchased at your participating local pharmacy Basic Formulary covers most common prescription drugs	Offers the broader coverage of our two plans Lower annual deductible You pay nothing for Preferred Generics through our mail order Low copays for Preferred Generic drugs purchased at your participating local pharmacy Enhanced Formulary with broader coverage offering more brand drugs
Premium	$37.40	$51.50
Deductible	$320.00 (Applies to all tiers)	$140.00 (Applies to tiers 3,4 & 5)

	Select Plan Cost Sharing				Preferred Plan Cost Sharing
Drug Tier	Retail In-Network Pharmacy		Retail Out- Of-Network Pharmacy	Mail Order	Retail In-Network Pharmacy		Retail Out-Of-Network Pharmacy	Mail Order
Drug Tier	34-Day Supply	90-Day Supply	34-Day Supply	90-Day Supply	34-Day Supply	90-Day Supply	34-Day Supply	90-Day Supply
Preferred Generics Tier 1	$3	$9	$3	$0	$3	$9	$3	$0
Non-Preferred Generics Tier 2	$9	$27	$9	$24	$9	$27	$9	$21
Preferred Brands Tier 3	$45	$135	$45	$122	$45	$113	$45	$90
Non-Preferred Brands Tier 4	$95	$285	$95	$257	$95	$238	$95	$190
Specialty Tier 5	25%	25%	25%	25%	29%	29%	29%	29%

The Coverage Gap	$2,930After your total yearly drug costs reach $2,930, you receive a discount on brand-name drugs and pay 86% of the Plan's costs for all generic drugs, until your yearly out-of-pocket drug costs reach $4,700. The discount you receive on brand-name drugs during the coverage gap is approximately 50%.
Cata- strophic Coverage	$4,700After your yearly out-of-pocket drug costs reach $4,700, you pay the greater of: A $2.60 copay for generic (including brand-name drugs treated as generic) and a $6.50 copay for all other drugs, or 5% coinsurance. We pay the rest.
	View Details \| Enroll Now - Select Plan	View Details \| Enroll Now - Preferred Plan

Updated 10/01/11

FIRST UNITED AMERICAN Part D Prescription Drug Plans

This website is intended to provide you with information about Medicare prescription drug coverage so you can make an informed decision about how Medicare Part D can help you manage your prescription drug costs. First United American Life Insurance Company is a Medicare-approved Part D sponsor.

Medicare Complaint Form: Click the link below to submit feedback about your prescription drug plan directly to Medicare:
https://www.medicare.gov/MedicareComplaintForm/home.aspx