There are 48 stand-alone Medicare Part D plans in North Carolina 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
HYDROXYZINE 50MG/ML VIAL (25 X 1 ML VIALSD) (NDC: 00517560125) 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![]() ![]() |
$15.20 | $175 | No Gap Coverage | 1 | Preferred Generic | $4.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Fox Value Plan![]() ![]() |
$18.80 | $295 | No Gap Coverage | 2 | Tier 2 | $17.00 | $51.00 | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Value![]() ![]() |
$23.40 | $0 | No Gap Coverage | 1 | Preferred Generic | $8.00 | $16.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver![]() ![]() |
$28.00 | $295 | No Gap Coverage | 1 | Tier 1 - Preferred Generic | $5.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Value![]() ![]() |
$30.20 | $295 | No Gap Coverage | 1 | Generic | $8.00 | $12.00 | 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 |
|
HealthSpring Prescription Drug Plan -Reg 8![]() ![]() |
$31.40 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier![]() ![]() |
$31.70 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | n/a | None | |
Browse Plan Formulary | |||||||||
BravoRx![]() ![]() |
$31.90 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
Fox Grand Plan![]() ![]() |
$31.90 | $185 | Some Generics | 2 | Tier 2 | $19.00 | $38.00 | None | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Value![]() ![]() |
$32.20 | $295 | No Gap Coverage | 1 | Generic | 23% | 23% | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Gold![]() ![]() |
$32.30 | $0 | No Gap Coverage | 1 | Generic | $6.00 | $12.00 | 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 |
|
Prescriba Rx Bronze![]() ![]() |
$32.40 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
Community CCRx Basic![]() ![]() |
$32.80 | $295 | No Gap Coverage | 1 | Generic | $0.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Advantage Star Plan by RxAmerica![]() ![]() |
$33.40 | $295 | No Gap Coverage | 1 | Preferred Generic | $4.75 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials![]() ![]() |
$33.90 | $215 | No Gap Coverage | 2 | Tier 2 - Non-Preferred Generic | $14.00 | $28.00 | P | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver![]() ![]() |
$34.50 | $295 | No Gap Coverage | 1 | Tier 1 Preferred Generic | $4.00 | $12.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One![]() ![]() |
$35.00 | $295 | No Gap Coverage | 1 | Tier 1 | $2.50 | $6.25 | 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 |
|
WellCare Classic![]() ![]() |
$35.40 | $295 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1![]() ![]() |
$35.80 | $295 | No Gap Coverage | 4 | Injectable | 25% | n/a | None | |
Browse Plan Formulary | |||||||||
MedicareRx Rewards Value![]() ![]() |
$36.70 | $130 | No Gap Coverage | 4 | Tier 4 Non-Specialty Injectable | 29% | 29% | None | |
Browse Plan Formulary | |||||||||
WellCare Signature![]() ![]() |
$36.80 | $0 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Choice![]() ![]() |
$37.30 | $0 | No Gap Coverage | 1 | Generic | $6.00 | $6.00 | None | |
Browse Plan Formulary | |||||||||
Advantage Freedom Plan by RxAmerica![]() ![]() |
$37.80 | $0 | No Gap Coverage | 1 | Preferred Generic | $5.00 | $0.00 | 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 |
|
AdvantraRx Premier![]() ![]() |
$39.10 | $0 | No Gap Coverage | 1 | Preferred Generic | $5.00 | $10.00 | None | |
Browse Plan Formulary | |||||||||
Blue Medicare Rx Standard![]() ![]() |
$39.40 | $0 | No Gap Coverage | 1 | Tier 1 - Generic | $8.00 | $24.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-007![]() ![]() |
$39.40 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred![]() ![]() |
$39.90 | $0 | No Gap Coverage | 1 | Tier 1-Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
UA Medicare Part D Rx Covg - Silver Plan![]() ![]() |
$41.50 | $130 | No Gap Coverage | 1 | Generic | $4.00 | $10.00 | None | |
Browse Plan Formulary | |||||||||
Sterling Rx![]() ![]() |
$42.40 | $295 | No Gap Coverage | 1 | Generic | $7.00 | $14.00 | 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 |
|
UnitedHealth Rx Basic![]() ![]() |
$42.60 | $0 | No Gap Coverage | 1 | Tier 1 - Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-066![]() ![]() |
$43.70 | $295 | No Gap Coverage | 1 | Preferred Generic | 15% | 15% | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two![]() ![]() |
$45.50 | $0 | No Gap Coverage | 2 | Tier 2 | $6.00 | $15.00 | None | |
Browse Plan Formulary | |||||||||
UA Medicare Part D Prescription Drug Cov![]() ![]() |
$45.80 | $0 | No Gap Coverage | 1 | Generic | $6.00 | $15.00 | None | |
Browse Plan Formulary | |||||||||
Community CCRx Choice![]() ![]() |
$47.00 | $0 | No Gap Coverage | 1 | Generic | $5.00 | n/a | None | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier Plus![]() ![]() |
$54.80 | $0 | Many Generics | 1 | Preferred Generic | $4.00 | $8.00 | 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 |
|
SilverScript Plus![]() ![]() |
$55.50 | $50 | Many Generics | 2 | Generic | $9.00 | $23.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 2![]() ![]() |
$55.60 | $0 | No Gap Coverage | 4 | Injectable | 33% | n/a | None | |
Browse Plan Formulary | |||||||||
Community CCRx Gold![]() ![]() |
$62.30 | $0 | All Generics | 1 | Generic | $5.00 | n/a | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus![]() ![]() |
$63.50 | $0 | Some Generics | 2 | Tier 2 - Non-Preferred Generic | $10.00 | $20.00 | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three![]() ![]() |
$68.10 | $0 | Some Generics | 1 | Tier 1 | $6.00 | $15.00 | None | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Access![]() ![]() |
$68.20 | $0 | All Generics | 1 | Generic | $6.00 | $6.00 | 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 |
|
Blue Medicare Rx Enhanced![]() ![]() |
$68.80 | $0 | All Generics | 1 | Tier 1 - Generic | $8.00 | $24.00 | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold![]() ![]() |
$73.40 | $0 | No Gap Coverage | 1 | Tier 1 Preferred Generics | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Prescriba Rx Platinum![]() ![]() |
$74.20 | $0 | All Generics | 1 | Generic | $6.00 | $12.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced![]() ![]() |
$74.40 | $0 | Many Generics | 1 | Tier 1 - Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Complete![]() ![]() |
$77.50 | $0 | Many Generics | 2 | Generic | $7.50 | $19.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-036![]() ![]() |
$98.90 | $0 | Many Generics | 1 | Preferred Generic | $7.00 | $0.00 | 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 |
|
Aetna Medicare Rx Premier![]() ![]() |
$128.50 | $0 | Many Generics | 2 | Tier 2 - Non-Preferred Generic | $10.00 | $20.00 | P | |
Browse Plan Formulary |
|