There are 9 stand-alone Medicare Part D plans in Puerto Rico 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
POLYMYXIN B SULFATE VIAL (10 VIAL CRTN) (NDC: 55390013910) 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 |
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SilverScript Value |
$15.40 | $295 | No Gap Coverage | 1 | Generic | $8.00 | $12.00 | None | |
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Humana PDP Standard S2874-001 |
$18.00 | $295 | No Gap Coverage | 1 | Preferred Generic | 15% | 15% | None | |
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Humana PDP Enhanced S2874-002 |
$20.60 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | $0.00 | None | |
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AARP MedicareRx Saver |
$27.00 | $295 | No Gap Coverage | 2 | Tier 2 - Generic and Preferred Brand | $22.00 | $51.00 | None | |
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SilverScript Plus |
$34.80 | $50 | Many Generics | 2 | Generic | $9.00 | $22.50 | None | |
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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 |
$36.10 | $0 | No Gap Coverage | 2 | Tier 2 - Generic and Preferred Brand | $38.00 | $99.00 | None | |
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UnitedHealth Rx Basic |
$41.50 | $0 | No Gap Coverage | 2 | Tier 2 - Generic and Preferred Brand | $35.00 | $90.00 | None | |
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SilverScript Complete |
$44.80 | $0 | Many Generics | 2 | Generic | $7.00 | $17.50 | None | |
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AARP MedicareRx Enhanced |
$69.80 | $0 | Many Generics | 2 | Tier 2 - Generic and Preferred Brand | $39.00 | $102.00 | None | |
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