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Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance 30-Day Supply | Total Formulary Drugs | |||
---|---|---|---|---|---|---|---|---|
SilverScript SmartRx (PDP) (S5601-201) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$6.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 49% Specialty Tier: 25% | 3,564 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance | Total Drugs | |||
---|---|---|---|---|---|---|---|---|
SilverScript Plus (PDP) (S5601-053) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$62.90 | $0 | Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33% | 3,060 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance |
State Members | |||
---|---|---|---|---|---|---|---|---|
SilverScript Choice (PDP) (S5601-052) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.30 | $320 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 43% Specialty Tier: 27% | 30,152 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Saver Plus (PDP) (S5921-371) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 17,388 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Preferred (PDP) (S5820-025) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$90.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: 40% Specialty Tier: 33% | 11,661 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Basic Rx Plan (PDP) (S5884-110) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$25.10 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 25% | 9,565 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Classic (PDP) (S4802-090) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $30.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 7,655 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance | Total Drugs | |||
---|---|---|---|---|---|---|---|---|
SilverScript SmartRx (PDP) (S5601-201) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$6.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 49% Specialty Tier: 25% | 3,564 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Value Script (PDP) (S4802-159) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$14.30 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $43.00 Non-Preferred Drug: 47% Specialty Tier: 25% select insulin pay $35 copay | 3,466 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Wellness Rx (PDP) (S4802-195) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$14.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $39.00 Non-Preferred Drug: 47% Specialty Tier: 25% select insulin pay $35 copay | 3,466 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Walmart Value Rx Plan (PDP) (S5884-205) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$17.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 19% Non-Preferred Drug: 35% Specialty Tier: 25% | 3,175 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure Rx (PDP) (S5617-128) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00 | 3,177 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Saver Plus (PDP) (S5921-371) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 3,110 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Classic (PDP) (S4802-090) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $30.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 3,094 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Medicare Rx Select (PDP) (S5810-303) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.10 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $47.00 Non-Preferred Drug: 42% Specialty Tier: 25% | 3,466 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
SilverScript Choice (PDP) (S5601-052) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.30 | $320 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 43% Specialty Tier: 27% | 3,014 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Elixir RxPlus (PDP) (S7694-026) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.90 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: 15% Non-Preferred Drug: 26% Specialty Tier: 25% | 3,182 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure-Essential Rx (PDP) (S5617-305) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$24.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 18% Non-Preferred Drug: 45% Specialty Tier: 25% | 3,140 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Mutual of Omaha Rx Premier (PDP) (S7126-095) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$25.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 23% Non-Preferred Drug: 40% Specialty Tier: 25% select insulin pay $25 copay | 2,943 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Basic Rx Plan (PDP) (S5884-110) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$25.10 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 25% | 3,074 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Medicare Rx Saver (PDP) (S5810-060) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$25.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $39.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 3,094 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
A few notes to help with the understanding of the 2021 Medicare Part D Plan chart above.
Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information. Through the application process we will provide you with the most up-to-the-minute information/pricing. |