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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) (S5601-190) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$6.80 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 49% Specialty Tier: 25% | 3,631 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) (S5601-031) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$58.80 | $0 | Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33% select insulin pay $35 copay | 3,309 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) (S5601-030) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$28.80 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 17% Non-Preferred Drug: 38% Specialty Tier: 25% | 120,394 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Wellcare Value Script (PDP) (S4802-150) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$12.90 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: 47% Specialty Tier: 25% | 100,539 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Walmart Value Rx Plan (PDP) (S5884-194) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.70 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 18% Non-Preferred Drug: 38% Specialty Tier: 25% | 63,156 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure Rx (PDP) (S5617-222) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$29.40 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $28.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00 | 62,605 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Preferred (PDP) (S5820-014) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$92.50 | $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% | 59,062 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) (S5601-190) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$6.80 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 49% Specialty Tier: 25% | 3,631 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Wellcare Value Script (PDP) (S4802-150) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$12.90 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $42.00 Non-Preferred Drug: 47% Specialty Tier: 25% select insulin pay $35 copay | 3,471 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Clear Spring Health Premier Rx (PDP) (S6946-041) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.20 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 45% Specialty Tier: 25% | 3,159 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Walmart Value Rx Plan (PDP) (S5884-194) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.70 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 18% Non-Preferred Drug: 38% Specialty Tier: 25% | 3,252 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Wellcare Classic (PDP) (S4802-086) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$27.30 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $6.00 Preferred Brand: $39.00 Non-Preferred Drug: 36% Specialty Tier: 25% | 3,136 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Clear Spring Health Value Rx (PDP) (S6946-012) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$27.60 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $42.00 Non-Preferred Drug: 39% Specialty Tier: 25% | 3,146 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
SilverScript Choice (PDP) (S5601-030) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$28.80 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: 17% Non-Preferred Drug: 38% Specialty Tier: 25% | 3,144 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Walgreens (PDP) (S5921-396) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$29.30 | $310 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Drug: 40% Specialty Tier: 27% | 3,194 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure Rx (PDP) (S5617-222) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$29.40 | $480 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $28.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00 | 3,238 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
A few notes to help with the understanding of the 2022 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. |