There are 23 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
DEGARELIX INJ (2X120MG ) (NDC: 55566840101) 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 |
$13.70 | $175 | No Gap Coverage | 4 | Specialty-Generic and Brand | 28% | n/a | P Q:2 /30Days | |
Browse Plan Formulary | |||||||||
AdvantraRx Value |
$22.20 | $0 | No Gap Coverage | 4 | Specialty-Generic and Brand | 33% | n/a | P Q:2 /30Days | |
Browse Plan Formulary | |||||||||
AmeriHealth Advantage Rx Option I |
$28.60 | $295 | No Gap Coverage | 4 | Tier 4 | 25% | n/a | P | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier |
$28.70 | $0 | No Gap Coverage | 4 | Specialty-Generic and Brand | 33% | n/a | P Q:2 /30Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One |
$30.00 | $295 | No Gap Coverage | 3 | Tier 3 | $94.00 | $235.00 | 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 |
|
WellCare Classic |
$31.40 | $295 | No Gap Coverage | 3 | Tier 3 | $78.00 | $234.00 | P Q:2 /180Days | |
Browse Plan Formulary | |||||||||
BravoRx |
$31.60 | $295 | No Gap Coverage | 3 | Tier 3 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
MedicareRx Rewards Value |
$32.90 | $130 | No Gap Coverage | 5 | Tier 5. | 29% | n/a | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials |
$33.40 | $195 | No Gap Coverage | 5 | Tier 5 - Specialty | 25% | 25% | P Q:2 /365Days | |
Browse Plan Formulary | |||||||||
WellCare Signature |
$33.90 | $0 | No Gap Coverage | 3 | Tier 3 | $79.00 | $237.00 | P Q:2 /180Days | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$35.30 | $295 | No Gap Coverage | 5 | Specialty | 25% | n/a | P Q:2 /365Days | |
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 |
$36.90 | $0 | No Gap Coverage | 4 | Specialty-Generic and Brand | 33% | n/a | P Q:2 /30Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$39.50 | $0 | No Gap Coverage | 4 | Tier 4 | $83.00 | $207.50 | P | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-064 |
$39.50 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 46% | 46% | P Q:2 /365Days | |
Browse Plan Formulary | |||||||||
Sterling Rx |
$42.10 | $295 | No Gap Coverage | 2 | Preferred Brand | $25.00 | $50.00 | None | |
Browse Plan Formulary | |||||||||
UPMC for Life Prescription Drug Plan |
$44.10 | $0 | No Gap Coverage | 4 | Specialty | 33% | n/a | P | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-005 |
$44.90 | $0 | No Gap Coverage | 4 | Specialty | 33% | n/a | P Q:2 /365Days | |
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 | 5 | Specialty | 33% | n/a | P Q:2 /365Days | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier Plus |
$52.80 | $0 | Many Generics | 4 | Specialty-Generic and Brand | 33% | n/a | P Q:2 /30Days | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus |
$63.90 | $0 | Some Generics | 5 | Tier 5 - Specialty | 33% | 33% | P Q:2 /365Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$72.60 | $0 | Some Generics | 3 | Tier 3 | $60.00 | $150.00 | P | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-034 |
$95.40 | $0 | Many Generics | 4 | Specialty | 33% | n/a | P Q:2 /365Days | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier |
$99.90 | $0 | Many Generics | 5 | Tier 5 - Specialty | 33% | 33% | P Q:2 /365Days | |
Browse Plan Formulary |
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