There are 20 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
RAPTIVA 125MG KIT 4 X VIAL SD PKG (4 X VIALSD PKGCOM) (NDC: 50242005804) 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 |
||||||
AARP MedicareRx Saver |
$22.40 | $295 | No Gap Coverage | 4 | Tier 4 - Specialty (Generic, Brand) | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
Community CCRx Basic |
$25.40 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | 45% | n/a | P Q:4 /28Days | |
Browse Plan Formulary | |||||||||
Prescriba Rx Bronze |
$28.80 | $295 | No Gap Coverage | 3 | Tier 3 | 25% | 25% | P Q:4 /28Days | |
Browse Plan Formulary | |||||||||
BravoRx |
$31.60 | $295 | No Gap Coverage | 3 | Tier 3 | 25% | 25% | P Q:8 /30Days | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold |
$32.10 | $0 | No Gap Coverage | 3 | Specialty | 33% | n/a | P Q:4 /28Days | |
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 |
|
BlueRx Value |
$33.10 | $295 | No Gap Coverage | 4 | Specialty | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$34.80 | $0 | No Gap Coverage | 4 | Tier 4 - Specialty (Generic, Brand) | 33% | 30% | P | |
Browse Plan Formulary | |||||||||
Community CCRx Choice |
$42.60 | $0 | No Gap Coverage | 4 | Specialty | 33% | n/a | P Q:4 /28Days | |
Browse Plan Formulary | |||||||||
SecureRx - Option 4 |
$43.00 | $295 | No Gap Coverage | 3 | Tier 3 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic |
$43.10 | $0 | No Gap Coverage | 4 | Tier 4 - Specialty (Generic, Brand) | 33% | 30% | P | |
Browse Plan Formulary | |||||||||
SecureRx - Option 3 |
$44.60 | $0 | No Gap Coverage | 3 | Specialty Drugs | 30% | 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 |
|
BlueRx Plus |
$49.10 | $0 | No Gap Coverage | 4 | Specialty | 33% | 33% | P | |
Browse Plan Formulary | |||||||||
AmeriHealth Rx Option I |
$54.30 | $295 | No Gap Coverage | 4 | Tier 4 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
AmeriHealth Rx Option II |
$58.90 | $0 | No Gap Coverage | 4 | Specialty | 33% | 33% | P | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum |
$65.00 | $0 | All Generics | 3 | Specialty | 33% | n/a | P Q:4 /28Days | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold |
$66.60 | $0 | No Gap Coverage | 5 | Tier 5 Specialty | 33% | n/a | None | |
Browse Plan Formulary | |||||||||
Community CCRx Gold |
$75.10 | $0 | All Generics | 4 | Specialty | 33% | n/a | P Q:4 /28Days | |
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 |
$76.40 | $0 | Many Generics | 4 | Tier 4 - Specialty (Generic, Brand) | 33% | 30% | P | |
Browse Plan Formulary | |||||||||
SecureRx - Option 1 |
$86.90 | $0 | Many Generics | 4 | Specialty Drugs | 30% | n/a | P | |
Browse Plan Formulary | |||||||||
BlueRx Complete |
$108.00 | $0 | Many Generics | 4 | Specialty | 33% | 33% | P | |
Browse Plan Formulary |
|