Click on the Benefits & Contact Info button for more plan details
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) (S5601-181) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$7.30 | $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 | |||
---|---|---|---|---|---|---|---|---|
Indy Health EliteRx (PDP) (S3535-005) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$47.10 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33% | 3,578 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) (S5601-012) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$32.90 | $345 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 26% | 179,813 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Preferred (PDP) (S5820-005) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$87.20 | $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% | 94,976 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Classic (PDP) (S4802-080) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$33.80 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $33.00 Non-Preferred Drug: 34% Specialty Tier: 25% | 53,745 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Saver Plus (PDP) (S5921-351) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$34.30 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $5.00 Preferred Brand: $33.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 53,247 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Elixir RxSecure (PDP) (S7694-006) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$35.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: 15% Non-Preferred Drug: 34% Specialty Tier: 25% | 52,616 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) (S5601-181) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$7.30 | $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: ![]() | ||||||||
Clear Spring Health Premier Rx (PDP) (S6946-032) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$13.60 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: 42% Specialty Tier: 25% | 3,276 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Elixir RxPlus (PDP) (S7694-126) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$15.60 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $6.00 Preferred Brand: $43.00 Non-Preferred Drug: 45% Specialty Tier: 25% | 3,243 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Wellness Rx (PDP) (S4802-175) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$15.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: 46% 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) (S5884-185) 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: ![]() | ||||||||
WellCare Value Script (PDP) (S4802-141) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$17.80 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $6.00 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: ![]() | ||||||||
Cigna Secure-Essential Rx (PDP) (S5617-285) 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: 50% Specialty Tier: 25% | 3,140 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Mutual of Omaha Rx Premier (PDP) (S7126-075) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$24.80 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 23% Non-Preferred Drug: 45% Specialty Tier: 25% select insulin pay $25 copay | 2,943 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Express Scripts Medicare - Saver (PDP) (S5660-222) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$25.90 | $285 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Drug: 50% Specialty Tier: 28% select insulin pay $35 copay | 2,951 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Medicare Rx Select (PDP) (S5810-280) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$26.40 | $415 | 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: ![]() | ||||||||
Clear Spring Health Value Rx (PDP) (S6946-003) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$29.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $42.00 Non-Preferred Drug: 34% Specialty Tier: 25% | 3,253 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure Rx (PDP) (S5617-215) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$30.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $30.00 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: ![]() |
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. |