through mail order) reach  $7,4 00 you pay the greater of: 
•5% of the cost, or 
•$4.15 copay for generic (including brand drugs treated as generic) and a  $10.35 copay for all other 
drugs 9
S5884_SB_PD_PDP_138000_2023_M Summary of Benefits S5884138000SB23 To find out more about the coverage and costs of Original Medicare, look in the current “Medicare &You” 
handbook. View it online at  http://www.medicare.gov or get acopy by calling 1-800-MEDICARE (1-800-633-4227),