There are 38 stand-alone Medicare Part D plans in Indiana 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
PLASMA-LYTE 56/DEXTROSE 5% (1000 ML BAG) (NDC: 00338014704) 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 |
||||||
SilverScript Value |
$28.00 | $295 | No Gap Coverage | 2 | Preferred Brand | $33.50 | $75.50 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver |
$28.20 | $295 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $59.65 | $163.95 | None | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Value |
$28.90 | $295 | No Gap Coverage | 2 | Preferred Brand | 23% | 23% | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Bronze |
$29.80 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
Community CCRx Basic |
$31.80 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | 45% | n/a | None | |
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 |
|
BravoRx |
$32.50 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One |
$33.50 | $295 | No Gap Coverage | 2 | Tier 2 | $30.00 | $75.00 | P | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials |
$33.90 | $200 | No Gap Coverage | 4 | Tier 4 - Non-Preferred Brand | $70.00 | $140.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$34.80 | $295 | No Gap Coverage | 4 | Injectable | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
WellCare Classic |
$34.90 | $295 | No Gap Coverage | 2 | Tier 2 | $31.00 | $93.00 | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver |
$35.00 | $295 | No Gap Coverage | 3 | Tier 3 Preferred Brand | $21.00 | $63.00 | None | |
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 |
|
Medco Medicare Prescription Plan - Choice |
$35.10 | $0 | No Gap Coverage | 2 | Preferred Brand | $35.00 | $87.50 | None | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Value |
$37.70 | $130 | No Gap Coverage | 4 | Tier 4 Non-Specialty Injectable | 29% | 29% | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold |
$38.40 | $0 | No Gap Coverage | 2 | Brand | $44.00 | $88.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Signature |
$38.40 | $0 | No Gap Coverage | 2 | Tier 2 | $39.00 | $117.00 | None | |
Browse Plan Formulary | |||||||||
UA Medicare Part D Rx Covg - Silver Plan |
$40.70 | $130 | No Gap Coverage | 2 | Preferred Brand | $40.00 | $100.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$41.20 | $0 | No Gap Coverage | 3 | Tier 3 | $38.00 | $95.00 | 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 Preferred |
$41.90 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $76.00 | $213.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-073 |
$42.10 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 47% | 47% | None | |
Browse Plan Formulary | |||||||||
Sterling Rx |
$42.40 | $295 | No Gap Coverage | 2 | Preferred Brand | $25.00 | $50.00 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Choice |
$43.40 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $60.00 | n/a | None | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic |
$44.00 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $89.00 | $252.00 | None | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Plus |
$44.30 | $0 | No Gap Coverage | 4 | Tier 4 Non-Specialty Injectable | 33% | 33% | None | |
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 Enhanced S5884-013 |
$47.90 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $70.00 | $175.00 | None | |
Browse Plan Formulary | |||||||||
UA Medicare Part D Prescription Drug Cov |
$48.70 | $0 | No Gap Coverage | 2 | Preferred Brand | $31.00 | $62.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$51.30 | $50 | Many Generics | 4 | Preferred Brand | $35.00 | $82.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus |
$58.80 | $0 | Some Generics | 4 | Tier 4 - Non-Preferred Brand | $78.00 | $156.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 2 |
$62.00 | $0 | No Gap Coverage | 4 | Injectable | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$66.10 | $0 | Some Generics | 2 | Tier 2 | $35.00 | $87.50 | 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 Gold |
$66.70 | $0 | All Generics | 3 | Non-Preferred Brand | $60.00 | n/a | None | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$66.90 | $0 | Many Generics | 3 | Preferred Brand | $39.00 | $92.00 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum |
$69.50 | $0 | All Generics | 2 | Brand | $44.00 | $88.00 | None | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Access |
$71.30 | $0 | All Generics | 2 | Preferred Brand | $35.00 | $87.50 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced |
$71.70 | $0 | Many Generics | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $95.00 | $270.00 | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold |
$72.30 | $0 | No Gap Coverage | 3 | Tier 3 Preferred Brand | $40.00 | $120.00 | None | |
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 |
|
Blue MedicareRx Premier |
$79.10 | $0 | Many Generics | 4 | Tier 4 Non-Specialty Injectable | 33% | 33% | None | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-043 |
$98.40 | $0 | Many Generics | 3 | Non-Preferred Brand | $70.00 | $175.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier |
$100.90 | $0 | Many Generics | 4 | Tier 4 - Non-Preferred Brand | $65.00 | $130.00 | None | |
Browse Plan Formulary |
|