HYDROMORPHONE HYDROCHLORIDE 2MG TABLETS (100 BOTPL ) (NDC: 00527135301)
2017 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional 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 |
AARP MedicareComplete Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$245* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:240 /30Days | $21.81 |
Browse Plan Formulary |
Aetna Medicare Elite Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:180 /30Days | $35.24 |
Browse Plan Formulary |
Affinity Medicare Passport Essentials (HMO)
![Email Prescription and/or Health Benefit details for Affinity Medicare Passport Essentials (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | n/a | Q:270 /30Days | $12.23 |
Browse Plan Formulary |
AgeWell New York FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for AgeWell New York FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | None | $23.03 |
Browse Plan Formulary |
AgeWell New York LiveWell (HMO)
![Email Prescription and/or Health Benefit details for AgeWell New York LiveWell (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$370* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$20.00 | n/a | None | $23.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AgeWell New York LiveWell (HMO)
![Email Prescription and/or Health Benefit details for AgeWell New York LiveWell (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$370* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$20.00 | n/a | None | $22.96 |
Browse Plan Formulary |
BasiCare with Part D (PPO)
![Email Prescription and/or Health Benefit details for BasiCare with Part D (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | Q:250 /30Days | $12.01 |
Browse Plan Formulary |
Elderplan FIDA Total Care (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Elderplan FIDA Total Care (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | Q:270 /30Days | $10.18 |
Browse Plan Formulary |
EmblemHealth VIP Value (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$16.00 | n/a | Q:180 /30Days | $19.52 |
Browse Plan Formulary |
Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Fidelis Fully Integrated Dual Advantage Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | Q:270 /30Days | $18.83 |
Browse Plan Formulary |
GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | Q:180 /30Days | $19.05 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | Q:270 /30Days | $9.52 |
Browse Plan Formulary |
PHP Care Complete FIDA (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for PHP Care Complete FIDA (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | Q:180 /30Days | $9.26 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$290* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $0.00 | Q:240 /30Days | $21.88 |
Browse Plan Formulary |
VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | n/a | Q:180 /30Days | $18.37 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Access (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.30 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$44.00 | $110.00 | Q:270 /30Days | $13.51 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.10 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $0.00 | Q:240 /30Days | $21.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.70 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | Q:240 /30Days | $21.88 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | Q:240 /30Days | $21.33 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO SNP)
![Email Prescription and/or Health Benefit details for Affinity Medicare Solutions (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.10 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | n/a | Q:270 /30Days | $12.23 |
Browse Plan Formulary |
CenterLight Healthcare Direct Complete Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for CenterLight Healthcare Direct Complete Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.10 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Generic |
$9.00 | n/a | Q:450 /30Days | $16.11 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO SNP)
![Email Prescription and/or Health Benefit details for Affinity Medicare Ultimate (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | n/a | Q:270 /30Days | $12.23 |
Browse Plan Formulary |
Elderplan Advantage For Nursing Home Residents (HMO SNP)
![Email Prescription and/or Health Benefit details for Elderplan Advantage For Nursing Home Residents (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:270 /30Days | $9.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Extra Help (HMO)
![Email Prescription and/or Health Benefit details for Elderplan Extra Help (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:270 /30Days | $10.28 |
Browse Plan Formulary |
Elderplan For Medicaid Beneficiaries (HMO SNP)
![Email Prescription and/or Health Benefit details for Elderplan For Medicaid Beneficiaries (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:270 /30Days | $10.24 |
Browse Plan Formulary |
Elderplan Plus Long Term Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Elderplan Plus Long Term Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:270 /30Days | $10.14 |
Browse Plan Formulary |
AgeWell New York BeWell (HMO SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York BeWell (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | None | $23.03 |
Browse Plan Formulary |
AgeWell New York CareWell (HMO SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York CareWell (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $23.03 |
Browse Plan Formulary |
AgeWell New York FeelWell (HMO SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York FeelWell (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $23.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ArchCare Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for ArchCare Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:270 /30Days | $16.50 |
Browse Plan Formulary |
EmblemHealth VIP Dual (HMO SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | n/a | Q:180 /30Days | $19.15 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex (HMO SNP)
![Email Prescription and/or Health Benefit details for Fidelis Dual Advantage Flex (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | n/a | Q:270 /30Days | $21.58 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex (HMO-POS)
![Email Prescription and/or Health Benefit details for Fidelis Medicare Advantage Flex (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | n/a | Q:270 /30Days | $21.58 |
Browse Plan Formulary |
Healthfirst CompleteCare (HMO SNP)
![Email Prescription and/or Health Benefit details for Healthfirst CompleteCare (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:270 /30Days | $9.52 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Healthfirst Life Improvement Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:270 /30Days | $9.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Senior Whole Health of New York NHC (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health of New York NHC (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:180 /30Days | $19.07 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Classic (HMO)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:180 /30Days | $18.39 |
Browse Plan Formulary |
VNSNY CHOICE Medicare Preferred (HMO SNP)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Preferred (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:180 /30Days | $18.39 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO SNP)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Total (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $18.42 |
Browse Plan Formulary |
Affinity Medicare Passport Select (HMO)
![Email Prescription and/or Health Benefit details for Affinity Medicare Passport Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | n/a | Q:270 /30Days | $12.23 |
Browse Plan Formulary |
WellCare Preferred (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Preferred (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:270 /30Days | $13.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage Plus 750B (PPO)
![Email Prescription and/or Health Benefit details for Today's Options Advantage Plus 750B (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$37.00 | $74.00 | Q:270 /30Days | $14.70 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$16.00 | n/a | Q:180 /30Days | $19.48 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$16.00 | n/a | Q:180 /30Days | $18.85 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$16.00 | n/a | Q:180 /30Days | $19.56 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$16.00 | n/a | Q:180 /30Days | $19.56 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$66.00 |
$240* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:240 /30Days | $21.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$86.00 |
$275 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | n/a | Q:360 /30Days | $32.09 |
Browse Plan Formulary |
Elderplan Healthy Balance (HMO-POS)
![Email Prescription and/or Health Benefit details for Elderplan Healthy Balance (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$93.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | n/a | Q:270 /30Days | $9.59 |
Browse Plan Formulary |
GoldValue with Part D (HMO-POS)
![Email Prescription and/or Health Benefit details for GoldValue with Part D (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.80 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $30.00 | Q:250 /30Days | $12.01 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:180 /30Days | $35.06 |
Browse Plan Formulary |
Today's Options Advantage Plus 450A (PPO)
![Email Prescription and/or Health Benefit details for Today's Options Advantage Plus 450A (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$103.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:270 /30Days | $14.70 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:180 /30Days | $35.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VNSNY CHOICE Medicare Maximum (HMO SNP)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Medicare Maximum (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$109.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $18.42 |
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Gold PPO with Part D (PPO)
![Email Prescription and/or Health Benefit details for Gold PPO with Part D (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$117.40 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:250 /30Days | $12.01 |
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Preferred Gold with Part D (HMO-POS)
![Email Prescription and/or Health Benefit details for Preferred Gold with Part D (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$166.80 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:250 /30Days | $12.01 |
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EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$229.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $19.48 |
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EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$229.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $18.85 |
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EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$229.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $19.56 |
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Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$229.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $19.56 |
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EmblemHealth VIP Gold Plus (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$320.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $19.48 |
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EmblemHealth VIP Gold Plus (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$320.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $18.85 |
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EmblemHealth VIP Gold Plus (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$320.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $19.56 |
Browse Plan Formulary |
EmblemHealth VIP Gold Plus (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$320.00 |
$330* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | n/a | Q:180 /30Days | $19.56 |
Browse Plan Formulary |