There are 37 stand-alone Medicare Part D plans in Utah meeting your criteria.
Caution: The 2009 Medicare Part D plan information below is for research purposes.
Click here to see 2024 Medicare Part D plans
OCTAGAM IMMUNE GLOBULIN INTRAVENOUS HUMAN 5% S/D 50MG (100 ML BOTGL) (NDC: 67467084303) 2009 Medicare Prescription Drug Plan (PDP) Information Click here for the Chart Legend | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information | Cost-Sharing | Drug Usage Mgmt |
|||
---|---|---|---|---|---|---|---|---|---|
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Order |
||||||
First Health Part D-Secure |
$18.50 | $175 | No Gap Coverage | 4 | Specialty-Generic and Brand | 28% | n/a | P | |
Browse Plan Formulary | |||||||||
AdvantraRx Value |
$27.20 | $0 | No Gap Coverage | 4 | Specialty-Generic and Brand | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
SilverScript Value |
$32.20 | $295 | No Gap Coverage | 4 | Specialty | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier |
$32.60 | $0 | No Gap Coverage | 4 | Specialty-Generic and Brand | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Prescriba Rx Bronze |
$32.80 | $295 | No Gap Coverage | 3 | Tier 3 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Aetna Medicare Rx Essentials |
$33.20 | $195 | No Gap Coverage | 5 | Tier 5 - Specialty | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
Advantage Star Plan by RxAmerica |
$37.70 | $295 | No Gap Coverage | 3 | Specialty | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
MedicareRx Rewards Value |
$37.70 | $130 | No Gap Coverage | 5 | Tier 5. | 29% | n/a | P | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver |
$38.30 | $295 | No Gap Coverage | 5 | Tier 5 Specialty Drugs | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One |
$38.50 | $295 | No Gap Coverage | 4 | Tier 4 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-089 |
$38.90 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 43% | 43% | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Community CCRx Basic |
$39.40 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | 55% | n/a | P | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold |
$39.50 | $0 | No Gap Coverage | 3 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver |
$40.00 | $295 | No Gap Coverage | 4 | Tier 4 - Specialty (Generic, Brand) | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-029 |
$40.00 | $0 | No Gap Coverage | 4 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$40.20 | $295 | No Gap Coverage | 5 | Specialty | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$42.90 | $0 | No Gap Coverage | 4 | Tier 4 - Specialty (Generic, Brand) | 33% | 30% | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
AdvantraRx Premier |
$43.20 | $0 | No Gap Coverage | 4 | Specialty-Generic and Brand | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Advantage Freedom Plan by RxAmerica |
$44.00 | $0 | No Gap Coverage | 3 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Sterling Rx |
$44.00 | $295 | No Gap Coverage | 4 | Specialty | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$44.10 | $0 | No Gap Coverage | 5 | Tier 5 | 33% | 33% | P | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic |
$48.70 | $0 | No Gap Coverage | 4 | Tier 4 - Specialty (Generic, Brand) | 33% | 30% | P | |
Browse Plan Formulary | |||||||||
Health Net Value Orange Option 2 |
$48.90 | $0 | No Gap Coverage | 5 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
AdvantraRx Premier Plus |
$61.30 | $0 | Many Generics | 4 | Specialty-Generic and Brand | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold |
$61.80 | $0 | No Gap Coverage | 5 | Tier 5 Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx - Costco Plus Plan |
$64.70 | $0 | Some Generics | 5 | Tier 5 - Specialty | 33% | 33% | P | |
Browse Plan Formulary | |||||||||
Community CCRx Choice |
$64.70 | $0 | No Gap Coverage | 4 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$65.70 | $50 | Many Generics | 6 | Specialty | 31% | n/a | P | |
Browse Plan Formulary | |||||||||
Regence Medicare Script |
$66.50 | $295 | No Gap Coverage | 5 | Specialty | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
AARP MedicareRx Enhanced |
$72.90 | $0 | Many Generics | 4 | Tier 4 - Specialty (Generic, Brand) | 33% | 30% | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$73.20 | $0 | Some Generics | 4 | Tier 4 | 33% | 33% | P | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum |
$74.00 | $0 | All Generics | 3 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Regence Medicare Script Enhanced |
$83.50 | $0 | Many Generics | 5 | Specialty | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$84.60 | $0 | Many Generics | 5 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Community CCRx Gold |
$85.20 | $0 | All Generics | 4 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Humana PDP Complete S5884-059 |
$98.30 | $0 | Many Generics | 4 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier |
$113.70 | $0 | Many Generics | 5 | Tier 5 - Specialty | 33% | 33% | P | |
Browse Plan Formulary |
|