There are 39 stand-alone Medicare Part D plans in Ohio 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
POLYGAM S/D 0.5GM VL W/DILUEN (NDC: 00944047169) 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 |
$16.90 | $175 | No Gap Coverage | 2 | Preferred Brand | $20.00 | n/a | P | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier |
$23.00 | $0 | No Gap Coverage | 2 | Preferred Brand | $29.00 | n/a | P | |
Browse Plan Formulary | |||||||||
AdvantraRx Value |
$23.40 | $0 | No Gap Coverage | 2 | Preferred Brand | $24.00 | $48.00 | P | |
Browse Plan Formulary | |||||||||
SilverScript Value |
$25.10 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $98.00 | $269.50 | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver |
$25.80 | $295 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $62.20 | $171.60 | 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 |
|
Prescriba Rx Bronze |
$27.30 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
Community CCRx Basic |
$27.90 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | 55% | n/a | P | |
Browse Plan Formulary | |||||||||
Advantage Star Plan by RxAmerica |
$28.60 | $295 | No Gap Coverage | 4 | Non-Preferred | 45% | 45% | P | |
Browse Plan Formulary | |||||||||
HealthSpring Prescription Drug Plan-Reg 14 |
$29.60 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver |
$30.30 | $295 | No Gap Coverage | 3 | Tier 3 Preferred Brand | $22.00 | $66.00 | P Q:10 /30Days | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$30.90 | $295 | No Gap Coverage | 2 | Preferred Brand | $42.00 | $84.00 | 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 |
|
Advantage Freedom Plan by RxAmerica |
$31.20 | $0 | No Gap Coverage | 4 | Non-Preferred | 45% | 45% | P | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials |
$31.80 | $200 | No Gap Coverage | 3 | Tier 3 - Preferred Brand | $30.00 | $60.00 | P | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Value |
$32.00 | $130 | No Gap Coverage | 4 | Tier 4 Non-Specialty Injectable | 29% | 29% | P | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold |
$32.10 | $0 | No Gap Coverage | 2 | Brand | $44.00 | $88.00 | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$38.20 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $84.10 | $237.30 | P | |
Browse Plan Formulary | |||||||||
Sterling Rx |
$38.20 | $295 | No Gap Coverage | 2 | Preferred Brand | $25.00 | $50.00 | 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 |
|
AdvantraRx Premier |
$39.50 | $0 | No Gap Coverage | 2 | Preferred Brand | $30.00 | $60.00 | P | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-012 |
$39.50 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $70.00 | $175.00 | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One |
$41.10 | $295 | No Gap Coverage | 3 | Tier 3 | $72.00 | $180.00 | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$41.40 | $0 | No Gap Coverage | 4 | Tier 4 | $81.00 | $202.50 | P | |
Browse Plan Formulary | |||||||||
Health Net Value Orange Option 2 |
$41.50 | $0 | No Gap Coverage | 2 | Preferred Brand | $39.00 | $78.00 | P | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Plus |
$42.40 | $0 | No Gap Coverage | 4 | Tier 4 Non-Specialty Injectable | 33% | 33% | 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 |
|
Humana PDP Standard S5884-072 |
$42.70 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 45% | 45% | P | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic |
$42.80 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $98.00 | $279.00 | P | |
Browse Plan Formulary | |||||||||
UPMC for Life Prescription Drug Plan |
$44.10 | $0 | No Gap Coverage | 2 | Preferred Brand | $32.00 | $80.00 | P | |
Browse Plan Formulary | |||||||||
Community CCRx Choice |
$46.10 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $60.00 | n/a | P | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$50.10 | $50 | Many Generics | 5 | Non-Preferred Brand | $95.00 | $261.00 | P | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx - Costco Plus Plan |
$51.60 | $0 | Some Generics | 3 | Tier 3 - Preferred Brand | $35.00 | $80.00 | 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 |
|
AdvantraRx Premier Plus |
$56.10 | $0 | Many Generics | 2 | Preferred Brand | $30.00 | $60.00 | P | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum |
$65.40 | $0 | All Generics | 2 | Brand | $44.00 | $88.00 | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$65.50 | $0 | Some Generics | 3 | Tier 3 | $60.00 | $150.00 | P | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$67.50 | $0 | Many Generics | 4 | Non-Preferred Brand | $98.00 | $270.00 | P | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold |
$70.40 | $0 | No Gap Coverage | 3 | Tier 3 Preferred Brand | $40.00 | $120.00 | P Q:10 /30Days | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced |
$73.30 | $0 | Many Generics | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $95.00 | $270.00 | 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 |
|
Blue MedicareRx Premier |
$77.80 | $0 | Many Generics | 4 | Tier 4 Non-Specialty Injectable | 33% | 33% | P | |
Browse Plan Formulary | |||||||||
Community CCRx Gold |
$78.40 | $0 | All Generics | 3 | Non-Preferred Brand | $60.00 | n/a | P | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier |
$94.90 | $0 | Many Generics | 3 | Tier 3 - Preferred Brand | $30.00 | $60.00 | P | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-042 |
$97.50 | $0 | Many Generics | 3 | Non-Preferred Brand | $70.00 | $175.00 | P | |
Browse Plan Formulary |
|