There are 31 stand-alone Medicare Part D plans in Pennsylvania 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
SURMONTIL 25MG CAPSULE (100 BOT) (NDC: 51285053802) 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 |
||||||
Community CCRx Basic |
$25.40 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | 45% | n/a | None | |
Browse Plan Formulary | |||||||||
Advantage Star Plan by RxAmerica |
$27.80 | $295 | No Gap Coverage | 2 | Preferred Brand | 25% | 30% | None | |
Browse Plan Formulary | |||||||||
AmeriHealth Advantage Rx Option I |
$28.60 | $295 | No Gap Coverage | 3 | Tier 3 | 25% | n/a | None | |
Browse Plan Formulary | |||||||||
SilverScript Value |
$28.70 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $98.00 | $269.50 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Bronze |
$28.80 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | 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 |
|
WellCare Classic |
$31.40 | $295 | No Gap Coverage | 3 | Tier 3 | $78.00 | $234.00 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold |
$32.10 | $0 | No Gap Coverage | 2 | Brand | $44.00 | $88.00 | None | |
Browse Plan Formulary | |||||||||
BlueRx Value |
$33.10 | $295 | No Gap Coverage | 2 | Preferred Brand | $32.00 | $80.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials |
$33.40 | $195 | No Gap Coverage | 4 | Tier 4 - Non-Preferred Brand | $69.00 | $138.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Signature |
$33.90 | $0 | No Gap Coverage | 3 | Tier 3 | $79.00 | $237.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$34.80 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $91.50 | $259.50 | 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 |
|
Health Net Orange Option 1 |
$35.30 | $295 | No Gap Coverage | 2 | Preferred Brand | $43.00 | $86.00 | None | |
Browse Plan Formulary | |||||||||
Advantage Freedom Plan by RxAmerica |
$38.30 | $0 | No Gap Coverage | 2 | Preferred Brand | 35% | 40% | None | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-064 |
$39.50 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 46% | 46% | None | |
Browse Plan Formulary | |||||||||
Sterling Rx |
$42.10 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $57.00 | $114.00 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Choice |
$42.60 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $60.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-005 |
$44.90 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $70.00 | $175.00 | 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 |
|
Health Net Value Orange Option 2 |
$46.60 | $0 | No Gap Coverage | 2 | Preferred Brand | $39.00 | $78.00 | None | |
Browse Plan Formulary | |||||||||
BlueRx Plus |
$49.10 | $0 | No Gap Coverage | 2 | Preferred Brand | $35.00 | $87.50 | None | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$51.50 | $50 | Many Generics | 5 | Non-Preferred Brand | $95.00 | $261.00 | None | |
Browse Plan Formulary | |||||||||
AmeriHealth Rx Option I |
$54.30 | $295 | No Gap Coverage | 3 | Tier 3 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
AmeriHealth Rx Option II |
$58.90 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $70.00 | $140.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus |
$63.90 | $0 | Some Generics | 4 | Tier 4 - Non-Preferred Brand | $86.00 | $172.00 | 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 |
|
Prescriba Rx Platinum |
$65.00 | $0 | All Generics | 2 | Brand | $44.00 | $88.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$69.10 | $0 | Many Generics | 4 | Non-Preferred Brand | $98.00 | $270.00 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Gold |
$75.10 | $0 | All Generics | 3 | Non-Preferred Brand | $60.00 | n/a | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced |
$76.40 | $0 | Many Generics | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $95.00 | $270.00 | None | |
Browse Plan Formulary | |||||||||
SecureRx - Option 1 |
$86.90 | $0 | Many Generics | 3 | Non-preferred Brand Drugs | $85.00 | $210.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-034 |
$95.40 | $0 | Many Generics | 3 | Non-Preferred Brand | $70.00 | $175.00 | 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 |
|
Aetna Medicare Rx Premier |
$99.90 | $0 | Many Generics | 4 | Tier 4 - Non-Preferred Brand | $65.00 | $130.00 | None | |
Browse Plan Formulary | |||||||||
BlueRx Complete |
$108.00 | $0 | Many Generics | 2 | Preferred Brand | $25.00 | $62.50 | None | |
Browse Plan Formulary |
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