There are 32 stand-alone Medicare Part D plans in Georgia 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
ORTHO TRI-CYCLEN LO TABLET (6 X 28 DLPK) (NDC: 00062125115) 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 |
$16.10 | $175 | No Gap Coverage | 3 | Non-Preferred Generic/Non-Preferred Brand | $46.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Bronze |
$22.50 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | Q:28 /28Days | |
Browse Plan Formulary | |||||||||
AdvantraRx Value |
$23.50 | $0 | No Gap Coverage | 3 | Non-Preferred Generic/Non-Preferred Brand | $55.00 | $165.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver |
$23.60 | $295 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $58.45 | $160.35 | None | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier |
$27.00 | $0 | No Gap Coverage | 3 | Non-Preferred Generic/Non-Preferred Brand | $64.00 | 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 |
|
Aetna Medicare Rx Essentials |
$27.60 | $200 | No Gap Coverage | 4 | Tier 4 - Non-Preferred Brand | $66.00 | $132.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Classic |
$28.30 | $295 | No Gap Coverage | 2 | Tier 2 | $33.00 | $99.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Value |
$28.70 | $295 | No Gap Coverage | 2 | Preferred Brand | $35.25 | $79.25 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Basic |
$29.20 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | 45% | n/a | Q:28 /28Days | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$30.60 | $295 | No Gap Coverage | 2 | Preferred Brand | $41.00 | $82.00 | Q:1 /1Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One |
$31.30 | $295 | No Gap Coverage | 3 | Tier 3 | $73.00 | $182.50 | 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 |
|
WellCare Signature |
$34.90 | $0 | No Gap Coverage | 2 | Tier 2 | $39.00 | $117.00 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold |
$35.10 | $0 | No Gap Coverage | 2 | Brand | $44.00 | $88.00 | Q:28 /28Days | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$38.10 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $74.05 | $207.15 | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier |
$39.10 | $0 | No Gap Coverage | 3 | Non-Preferred Generic/Non-Preferred Brand | $73.00 | $219.00 | None | |
Browse Plan Formulary | |||||||||
Sterling Rx |
$40.50 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $57.00 | $114.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-068 |
$40.80 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 46% | 46% | 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 |
|
UnitedHealth Rx Basic |
$42.20 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $92.00 | $261.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-009 |
$44.30 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $70.00 | $175.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Value Orange Option 2 |
$45.20 | $0 | No Gap Coverage | 2 | Preferred Brand | $39.00 | $78.00 | Q:1 /1Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$45.40 | $0 | No Gap Coverage | 4 | Tier 4 | $80.00 | $200.00 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Choice |
$50.40 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $60.00 | n/a | Q:28 /28Days | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$54.20 | $50 | Many Generics | 4 | Preferred Brand | $35.00 | $82.00 | 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 |
|
AdvantraRx Premier Plus |
$55.60 | $0 | Many Generics | 3 | Non-Preferred Generic/Non-Preferred Brand | $75.00 | $225.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus |
$63.60 | $0 | Some Generics | 4 | Tier 4 - Non-Preferred Brand | $76.00 | $152.00 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Gold |
$68.40 | $0 | All Generics | 3 | Non-Preferred Brand | $60.00 | n/a | Q:28 /28Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$71.30 | $0 | Some Generics | 3 | Tier 3 | $60.00 | $150.00 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum |
$71.80 | $0 | All Generics | 2 | Brand | $44.00 | $88.00 | Q:28 /28Days | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced |
$72.90 | $0 | Many Generics | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $95.00 | $270.00 | 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 |
|
SilverScript Complete |
$73.50 | $0 | Many Generics | 3 | Preferred Brand | $39.00 | $92.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier |
$99.70 | $0 | Many Generics | 4 | Tier 4 - Non-Preferred Brand | $65.00 | $130.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-038 |
$103.40 | $0 | Many Generics | 3 | Non-Preferred Brand | $70.00 | $175.00 | None | |
Browse Plan Formulary |
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