COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN (NDC: 68546031730)
2010 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 |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
First Health Part D-Secure (PDP)
![Email Prescription and/or Health Benefit details for First Health Part D-Secure (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.70 |
$175 |
No Gap Coverage |
4 |
Specialty - Generic and Brand |
28% | n/a | P Q:30 /30Days | $3,135.27 |
Browse Plan Formulary |
Community CCRx Basic (PDP)
![Email Prescription and/or Health Benefit details for Community CCRx Basic (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.60 |
$310 |
No Gap Coverage |
2 |
Preferred Brand |
30% | n/a | P Q:1 /30Days | $3,195.12 |
Browse Plan Formulary |
PrescribaRx Bronze (PDP)
![Email Prescription and/or Health Benefit details for PrescribaRx Bronze (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$310 |
No Gap Coverage |
3 |
Tier 3 |
25% | 25% | P Q:1 /30Days | $3,190.26 |
Browse Plan Formulary |
Humana Value S5884-104 (PDP)
![Email Prescription and/or Health Benefit details for Humana Value S5884-104 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$150 |
No Gap Coverage |
3 |
Non-Preferred Brand |
36% | 36% | P Q:30 /28Days | $3,127.12 |
Browse Plan Formulary |
AARP MedicareRx Saver (PDP)
![Email Prescription and/or Health Benefit details for AARP MedicareRx Saver (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.10 |
$310 |
No Gap Coverage |
4 |
Tier 4 Specialty |
25% | 25% | P | $3,145.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Rx Plan One (PDP)
![Email Prescription and/or Health Benefit details for CIGNA Medicare Rx Plan One (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.10 |
$310 |
No Gap Coverage |
4 |
Tier 4 |
25% | 25% | P | $3,144.65 |
Browse Plan Formulary |
AdvantraRx Value (PDP)
![Email Prescription and/or Health Benefit details for AdvantraRx Value (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.20 |
$100 |
No Gap Coverage |
4 |
Specialty - Generic and Brand |
30% | n/a | P Q:30 /30Days | $3,135.27 |
Browse Plan Formulary |
Medco Medicare Prescription Plan - Value (
![Email Prescription and/or Health Benefit details for Medco Medicare Prescription Plan - Value (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
No Gap Coverage |
4 |
Tier 4 |
25% | 25% | P Q:90 /90Days | $3,135.83 |
Browse Plan Formulary |
AmeriHealth Advantage (PDP)
![Email Prescription and/or Health Benefit details for AmeriHealth Advantage (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$310 |
No Gap Coverage |
5 |
Tier 5 |
25% | n/a | P | $3,465.25 |
Browse Plan Formulary |
BravoRx (PDP)
![Email Prescription and/or Health Benefit details for BravoRx (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
No Gap Coverage |
3 |
Tier 3 |
25% | 25% | P Q:30 /30Days | $3,135.77 |
Browse Plan Formulary |
Fox Value Plan (PDP)
![Email Prescription and/or Health Benefit details for Fox Value Plan (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.90 |
$310 |
No Gap Coverage |
5 |
Tier 5 |
25% | n/a | P | n/a |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Orange Option 1 (PDP)
![Email Prescription and/or Health Benefit details for Health Net Orange Option 1 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.90 |
$310 |
No Gap Coverage |
5 |
Tier 5 Specialty |
25% | n/a | P | $3,137.66 |
Browse Plan Formulary |
SilverScript Value (PDP)
![Email Prescription and/or Health Benefit details for SilverScript Value (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.60 |
$310 |
No Gap Coverage |
4 |
Specialty Tier |
25% | n/a | P | $3,159.81 |
Browse Plan Formulary |
Advantage Star Plan by RxAmerica (PDP)
![Email Prescription and/or Health Benefit details for Advantage Star Plan by RxAmerica (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.70 |
$310 |
No Gap Coverage |
3 |
Specialty |
25% | n/a | P | $3,159.83 |
Browse Plan Formulary |
PrescribaRx Gold (PDP)
![Email Prescription and/or Health Benefit details for PrescribaRx Gold (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$150 |
No Gap Coverage |
3 |
Specialty |
29% | n/a | P Q:1 /30Days | $3,190.26 |
Browse Plan Formulary |
HealthSpring Prescription Drug Plan -Reg 6
![Email Prescription and/or Health Benefit details for HealthSpring Prescription Drug Plan -Reg 6](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.50 |
$310 |
No Gap Coverage |
2 |
Tier 2 |
25% | 25% | P | $3,152.55 |
Browse Plan Formulary |
MedicareRx Rewards Standard (PDP)
![Email Prescription and/or Health Benefit details for MedicareRx Rewards Standard (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$310 |
No Gap Coverage |
4 |
Tier 4 Specialty Drugs |
25% | n/a | P | $3,325.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
EnvisionRxPlus Silver (PDP)
![Email Prescription and/or Health Benefit details for EnvisionRxPlus Silver (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$310 |
No Gap Coverage |
5 |
Tier 5 |
25% | 25% | None | $3,227.38 |
Browse Plan Formulary |
CIGNA Medicare Rx Plan Two (PDP)
![Email Prescription and/or Health Benefit details for CIGNA Medicare Rx Plan Two (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.60 |
$100 |
No Gap Coverage |
5 |
Tier 5 |
25% | 25% | P | $3,144.65 |
Browse Plan Formulary |
MedicareRx Rewards Plus (PDP)
![Email Prescription and/or Health Benefit details for MedicareRx Rewards Plus (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.90 |
$0 |
No Gap Coverage |
5 |
Tier 5 Specialty Drugs |
33% | n/a | P | $3,325.75 |
Browse Plan Formulary |
Community CCRx Choice (PDP)
![Email Prescription and/or Health Benefit details for Community CCRx Choice (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.40 |
$150 |
No Gap Coverage |
4 |
Specialty |
29% | n/a | P Q:1 /30Days | $3,195.12 |
Browse Plan Formulary |
Aetna Medicare Rx Plus (PDP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Rx Plus (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.70 |
$0 |
No Gap Coverage |
5 |
Tier 5 - Specialty |
33% | 33% | P | $3,170.64 |
Browse Plan Formulary |
AARP MedicareRx Preferred (PDP)
![Email Prescription and/or Health Benefit details for AARP MedicareRx Preferred (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.40 |
$0 |
No Gap Coverage |
4 |
Tier 4 Specialty |
33% | 33% | P | $3,145.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medco Medicare Prescription Plan - Choice
![Email Prescription and/or Health Benefit details for Medco Medicare Prescription Plan - Choice](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$100 |
No Gap Coverage |
4 |
Specialty |
30% | 30% | P Q:90 /90Days | $3,135.83 |
Browse Plan Formulary |
First Health Part D-Premier (PDP)
![Email Prescription and/or Health Benefit details for First Health Part D-Premier (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$150 |
No Gap Coverage |
4 |
Specialty - Generic and Brand |
29% | n/a | P Q:30 /30Days | $3,135.27 |
Browse Plan Formulary |
AdvantraRx Premier (PDP)
![Email Prescription and/or Health Benefit details for AdvantraRx Premier (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$0 |
No Gap Coverage |
4 |
Specialty - Generic and Brand |
33% | n/a | P Q:30 /30Days | $3,135.27 |
Browse Plan Formulary |
Humana Enhanced S5884-005 (PDP)
![Email Prescription and/or Health Benefit details for Humana Enhanced S5884-005 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.20 |
$0 |
No Gap Coverage |
4 |
Specialty |
33% | n/a | P Q:30 /28Days | $3,127.12 |
Browse Plan Formulary |
UA Medicare Part D Rx Covg - Silver Plan (
![Email Prescription and/or Health Benefit details for UA Medicare Part D Rx Covg - Silver Plan (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.90 |
$170 |
No Gap Coverage |
4 |
Specialty |
25% | 25% | P Q:90 /90Days | $3,135.74 |
Browse Plan Formulary |
Sterling Rx (PDP)
![Email Prescription and/or Health Benefit details for Sterling Rx (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.20 |
$310 |
No Gap Coverage |
3 |
Specialty |
25% | 25% | P Q:30 /30Days | $3,288.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CVS Caremark Plus (PDP)
![Email Prescription and/or Health Benefit details for CVS Caremark Plus (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.40 |
$50 |
No Gap Coverage |
6 |
Specialty Tier |
31% | n/a | P | $3,131.55 |
Browse Plan Formulary |
UA Medicare Part D Prescription Drug Cov (
![Email Prescription and/or Health Benefit details for UA Medicare Part D Prescription Drug Cov (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.10 |
$0 |
No Gap Coverage |
4 |
Specialty |
33% | 33% | P Q:90 /90Days | $3,135.74 |
Browse Plan Formulary |
SecureRx - Option 4 (PDP)
![Email Prescription and/or Health Benefit details for SecureRx - Option 4 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.30 |
$310 |
No Gap Coverage |
3 |
Tier 3 |
25% | 25% | None | $3,263.54 |
Browse Plan Formulary |
Advantage Freedom Plan by RxAmerica (PDP)
![Email Prescription and/or Health Benefit details for Advantage Freedom Plan by RxAmerica (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
No Gap Coverage |
4 |
Specialty |
33% | n/a | P | $3,153.72 |
Browse Plan Formulary |
Aetna Medicare Rx Essentials (PDP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Rx Essentials (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$310 |
No Gap Coverage |
5 |
Tier 5 Specialty |
25% | 25% | P | $3,170.64 |
Browse Plan Formulary |
SecureRx - Option 3 (PDP)
![Email Prescription and/or Health Benefit details for SecureRx - Option 3 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
No Gap Coverage |
3 |
Specialty Drugs |
33% | n/a | None | $3,263.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Rx 1 (PDP)
![Email Prescription and/or Health Benefit details for Geisinger Gold Rx 1 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.40 |
$310 |
No Gap Coverage |
2 |
Tier 2 |
25% | 25% | None | $3,126.46 |
Browse Plan Formulary |
BlueRx Plus (PDP)
![Email Prescription and/or Health Benefit details for BlueRx Plus (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.30 |
$0 |
No Gap Coverage |
4 |
Specialty Tier |
33% | 33% | None | $3,136.19 |
Browse Plan Formulary |
Health Net Value Orange Option 2 (PDP)
![Email Prescription and/or Health Benefit details for Health Net Value Orange Option 2 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.70 |
$0 |
No Gap Coverage |
5 |
Tier 5 Specialty |
33% | n/a | P | $3,137.66 |
Browse Plan Formulary |
UPMC for Life (PDP)
![Email Prescription and/or Health Benefit details for UPMC for Life (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.30 |
$0 |
No Gap Coverage |
4 |
Tier 4 - Specialty |
33% | n/a | Q:30 /30Days | $3,266.68 |
Browse Plan Formulary |
EnvisionRxPlus Gold (PDP)
![Email Prescription and/or Health Benefit details for EnvisionRxPlus Gold (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.80 |
$150 |
No Gap Coverage |
5 |
Tier 5 Specialty |
25% | n/a | None | $3,227.38 |
Browse Plan Formulary |
BlueRx Value (PDP)
![Email Prescription and/or Health Benefit details for BlueRx Value (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.20 |
$310 |
No Gap Coverage |
4 |
Specialty Tier |
25% | 25% | None | $3,136.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Rx Plan Three (PDP)
![Email Prescription and/or Health Benefit details for CIGNA Medicare Rx Plan Three (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.40 |
$0 |
Many Generics, Few Brands |
4 |
Tier 4 |
33% | 33% | P | $3,144.65 |
Browse Plan Formulary |
AdvantraRx Premier Plus (PDP)
![Email Prescription and/or Health Benefit details for AdvantraRx Premier Plus (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$61.20 |
$0 |
Many Generics |
5 |
Specialty - Generic and Brand |
33% | n/a | P Q:30 /30Days | $3,135.27 |
Browse Plan Formulary |
AmeriHealth Rx Option I (PDP)
![Email Prescription and/or Health Benefit details for AmeriHealth Rx Option I (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$65.50 |
$310 |
No Gap Coverage |
5 |
Tier 5 |
25% | 25% | Q:32 /30Days | $3,363.63 |
Browse Plan Formulary |
AmeriHealth Rx Option II (PDP)
![Email Prescription and/or Health Benefit details for AmeriHealth Rx Option II (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$66.70 |
$100 |
Many Generics |
5 |
Specialty |
30% | 30% | Q:32 /30Days | $3,363.63 |
Browse Plan Formulary |
CVS Caremark Complete (PDP)
![Email Prescription and/or Health Benefit details for CVS Caremark Complete (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$66.90 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P | $3,131.55 |
Browse Plan Formulary |
Medco Medicare Prescription Plan - Access
![Email Prescription and/or Health Benefit details for Medco Medicare Prescription Plan - Access](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.80 |
$0 |
Many Generics |
4 |
Specialty |
33% | 33% | P Q:90 /90Days | $3,135.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Community CCRx Gold (PDP)
![Email Prescription and/or Health Benefit details for Community CCRx Gold (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.30 |
$0 |
All Generics |
4 |
Specialty |
33% | n/a | P Q:1 /30Days | $3,195.12 |
Browse Plan Formulary |
AARP MedicareRx Enhanced (PDP)
![Email Prescription and/or Health Benefit details for AARP MedicareRx Enhanced (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$81.10 |
$0 |
Many Generics |
4 |
Tier 4 Specialty |
33% | 33% | P | $3,145.35 |
Browse Plan Formulary |
Aetna Medicare Rx Premier (PDP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Rx Premier (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$83.70 |
$0 |
Many Generics |
5 |
Tier 5 - Specialty |
33% | 33% | P | $3,170.64 |
Browse Plan Formulary |
BlueRx Complete (PDP)
![Email Prescription and/or Health Benefit details for BlueRx Complete (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$93.90 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | None | $3,136.19 |
Browse Plan Formulary |
Humana Complete S5884-034 (PDP)
![Email Prescription and/or Health Benefit details for Humana Complete S5884-034 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$100.10 |
$0 |
Many Generics |
4 |
Specialty |
33% | n/a | P Q:30 /28Days | $3,127.12 |
Browse Plan Formulary |
SecureRx - Option 1 (PDP)
![Email Prescription and/or Health Benefit details for SecureRx - Option 1 (PDP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$110.70 |
$0 |
Many Generics |
4 |
Specialty Drugs |
33% | n/a | None | $3,263.54 |
Browse Plan Formulary |