There are 50 stand-alone Medicare Part D plans in Utah 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
MOBAN 50MG TABLET (100 BOT) (NDC: 63481007670) 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![]() ![]() |
$18.50 | $175 | No Gap Coverage | 2 | Preferred Brand | $20.00 | n/a | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Value![]() ![]() |
$27.20 | $0 | No Gap Coverage | 2 | Preferred Brand | $24.00 | $48.00 | None | |
Browse Plan Formulary | |||||||||
HealthSpring Prescription Drug Plan-Reg 31![]() ![]() |
$30.70 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Value![]() ![]() |
$31.90 | $295 | No Gap Coverage | 2 | Preferred Brand | 23% | 23% | None | |
Browse Plan Formulary | |||||||||
SilverScript Value![]() ![]() |
$32.20 | $295 | No Gap Coverage | 2 | Preferred Brand | $36.00 | $81.00 | 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 |
|
First Health Part D-Premier![]() ![]() |
$32.60 | $0 | No Gap Coverage | 2 | Preferred Brand | $25.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Bronze![]() ![]() |
$32.80 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials![]() ![]() |
$33.20 | $195 | No Gap Coverage | 4 | Tier 4 - Non-Preferred Brand | $67.00 | $134.00 | None | |
Browse Plan Formulary | |||||||||
BravoRx![]() ![]() |
$36.50 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
SierraRx![]() ![]() |
$36.80 | $0 | No Gap Coverage | 2 | Brand | $45.00 | $135.00 | Q:120 /30Days | |
Browse Plan Formulary | |||||||||
Advantage Star Plan by RxAmerica![]() ![]() |
$37.70 | $295 | No Gap Coverage | 2 | Preferred Brand | 25% | 30% | 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 |
|
MedicareRx Rewards Value![]() ![]() |
$37.70 | $130 | No Gap Coverage | 2 | Tier 2 Preferred Brand | $45.50 | $113.75 | Q:120 /30Days | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver![]() ![]() |
$38.30 | $295 | No Gap Coverage | 4 | Tier 4 NonPreferred Brand | $75.00 | $225.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One![]() ![]() |
$38.50 | $295 | No Gap Coverage | 3 | Tier 3 | $91.00 | $227.50 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-089![]() ![]() |
$38.90 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 43% | 43% | None | |
Browse Plan Formulary | |||||||||
Community CCRx Basic![]() ![]() |
$39.40 | $295 | No Gap Coverage | 2 | Preferred Brand | 25% | n/a | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold![]() ![]() |
$39.50 | $0 | No Gap Coverage | 2 | Brand | $44.00 | $88.00 | 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 |
|
AARP MedicareRx Saver![]() ![]() |
$40.00 | $295 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $66.30 | $183.90 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-029![]() ![]() |
$40.00 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $70.00 | $175.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1![]() ![]() |
$40.20 | $295 | No Gap Coverage | 2 | Preferred Brand | $44.00 | $88.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Classic![]() ![]() |
$41.60 | $295 | No Gap Coverage | 3 | Tier 3 | $67.00 | $201.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred![]() ![]() |
$42.90 | $0 | No Gap Coverage | 2 | Tier 2 - Generic and Preferred Brand | $38.00 | $99.00 | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier![]() ![]() |
$43.20 | $0 | No Gap Coverage | 2 | Preferred Brand | $31.00 | $62.00 | 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 |
|
Advantage Freedom Plan by RxAmerica![]() ![]() |
$44.00 | $0 | No Gap Coverage | 2 | Preferred Brand | 35% | 40% | None | |
Browse Plan Formulary | |||||||||
Sterling Rx![]() ![]() |
$44.00 | $295 | No Gap Coverage | 2 | Preferred Brand | $25.00 | $50.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two![]() ![]() |
$44.10 | $0 | No Gap Coverage | 4 | Tier 4 | $80.00 | $200.00 | None | |
Browse Plan Formulary | |||||||||
Educators Rx Basic![]() ![]() |
$47.10 | $295 | No Gap Coverage | 2 | Preferred Brand | $30.00 | $90.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Signature![]() ![]() |
$47.20 | $0 | No Gap Coverage | 3 | Tier 3 | $79.00 | $237.00 | None | |
Browse Plan Formulary | |||||||||
UA Medicare Part D Rx Covg - Silver Plan![]() ![]() |
$47.70 | $110 | No Gap Coverage | 2 | Preferred Brand | $40.00 | $100.00 | 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 |
|
UA Medicare Part D Prescription Drug Cov![]() ![]() |
$47.90 | $0 | No Gap Coverage | 2 | Preferred Brand | $33.00 | $66.00 | None | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic![]() ![]() |
$48.70 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $94.00 | $267.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Value Orange Option 2![]() ![]() |
$48.90 | $0 | No Gap Coverage | 2 | Preferred Brand | $39.00 | $78.00 | None | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Choice![]() ![]() |
$49.80 | $0 | No Gap Coverage | 2 | Preferred Brand | $38.00 | $95.00 | None | |
Browse Plan Formulary | |||||||||
Educators Rx Advantage![]() ![]() |
$60.70 | $50 | No Gap Coverage | 2 | Preferred Brand | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier Plus![]() ![]() |
$61.30 | $0 | Many Generics | 2 | Preferred Brand | $30.00 | $60.00 | 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 |
|
EnvisionRxPlus Gold![]() ![]() |
$61.80 | $0 | No Gap Coverage | 4 | Tier 4 NonPreferred Brand | $75.00 | $225.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx - Costco Plus Plan![]() ![]() |
$64.70 | $0 | Some Generics | 4 | Tier 4 - Non-Preferred Brand | $90.00 | $180.00 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Choice![]() ![]() |
$64.70 | $0 | No Gap Coverage | 2 | Preferred Brand | $30.00 | n/a | None | |
Browse Plan Formulary | |||||||||
SilverScript Plus![]() ![]() |
$65.70 | $50 | Many Generics | 4 | Preferred Brand | $35.00 | $82.00 | None | |
Browse Plan Formulary | |||||||||
Regence Medicare Script![]() ![]() |
$66.50 | $295 | No Gap Coverage | 2 | Preferred Brand | $20.00 | $60.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced![]() ![]() |
$72.90 | $0 | Many Generics | 2 | Tier 2 - Generic and Preferred Brand | $39.00 | $102.00 | 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 |
|
CIGNA Medicare Rx Plan Three![]() ![]() |
$73.20 | $0 | Some Generics | 3 | Tier 3 | $60.00 | $150.00 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum![]() ![]() |
$74.00 | $0 | All Generics | 2 | Brand | $44.00 | $88.00 | None | |
Browse Plan Formulary | |||||||||
SierraRx Basic![]() ![]() |
$78.00 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | Q:120 /30Days | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Access![]() ![]() |
$79.60 | $0 | All Generics | 2 | Preferred Brand | $35.00 | $87.50 | None | |
Browse Plan Formulary | |||||||||
Regence Medicare Script Enhanced![]() ![]() |
$83.50 | $0 | Many Generics | 2 | Preferred Brand | $25.00 | $75.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Complete![]() ![]() |
$84.60 | $0 | Many Generics | 3 | Preferred Brand | $39.00 | $92.00 | 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 |
|
Community CCRx Gold![]() ![]() |
$85.20 | $0 | All Generics | 2 | Preferred Brand | $30.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-059![]() ![]() |
$98.30 | $0 | Many Generics | 3 | Non-Preferred Brand | $70.00 | $175.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier![]() ![]() |
$113.70 | $0 | Many Generics | 4 | Tier 4 - Non-Preferred Brand | $65.00 | $130.00 | None | |
Browse Plan Formulary |
|