HYSINGLA ER 40 MG TABLET (NDC: 59011027360)
2018 Medicare Prescription Drug Plan (MAPD) Information
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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 SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $546.55 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $546.55 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $546.55 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $546.55 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days | $519.91 |
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 |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days | $519.91 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days | $519.95 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days | $519.95 |
Browse Plan Formulary |
Brand New Day Bridges Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Bridges Drug Savings (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Classic Care Drug Savings (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
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 |
Brand New Day Classic Care Drug Savings (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Embrace Care Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Embrace Care Drug Savings (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Harmony Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Harmony Drug Savings (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day In Control Drug Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
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 |
Brand New Day In Control Drug Savings (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $516.24 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $516.24 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$0.00 |
$405 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $516.24 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $518.08 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $517.52 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $518.08 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $517.52 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $518.08 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $517.52 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $517.62 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $517.62 |
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 |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | None | $569.75 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$100.00 | n/a | None | $569.75 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | n/a | Q:30 /30Days | $540.86 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | n/a | Q:30 /30Days | $540.86 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | n/a | Q:60 /30Days | $503.18 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | n/a | Q:60 /30Days | $503.18 |
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 |
Molina Medicare Options Plus (HMO SNP)
|
$0.00 |
$405 |
to be determined |
3 |
Preferred Brand |
$47.00 | n/a | Q:60 /30Days | $503.18 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | None | $569.75 |
Browse Plan Formulary |
Traditional-LA (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$45.00 | n/a | Q:60 /30Days | $522.62 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$12.70 |
$0 |
to be determined |
4 |
Tier 4 |
$100.00 | n/a | None | $569.75 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$12.70 |
$0 |
to be determined |
4 |
Tier 4 |
$100.00 | n/a | None | $569.75 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$17.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $518.08 |
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 |
Health Net Healthy Heart (HMO)
|
$17.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:3 /1Days | $517.52 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$17.30 |
$405 |
to be determined |
3 |
Tier 3 |
25% | n/a | Q:30 /30Days | $547.21 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$17.30 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | n/a | Q:30 /30Days | $547.21 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
|
$19.60 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $516.24 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Premier (HMO)
|
$26.70 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $546.55 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Premier (HMO)
|
$26.70 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $546.55 |
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 |
Easy Choice Plus Plan (HMO)
|
$28.30 |
$405 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $516.24 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$28.30 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $516.24 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | None | $569.75 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$32.30 |
$0 |
to be determined |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days | $519.91 |
Browse Plan Formulary |
Brand New Day Bridges Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Bridges Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
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 |
Brand New Day Classic Choice for Medi-Medi (HMO)
|
$35.50 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Classic Choice for Medi-Medi (HMO)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Dual Coverage (HMO SNP)
|
$35.50 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Dual Coverage (HMO SNP)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Embrace Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Embrace Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
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 |
Brand New Day Harmony Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day Harmony Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day In Control Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Brand New Day In Control Choice for Medi-Medi (HMO SNP)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $499.38 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$35.50 |
$140 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.16 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$35.50 |
$140 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.16 |
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 |
Health Net Seniority Plus Amber II (HMO SNP)
|
$35.50 |
$190 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.10 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$35.50 |
$190 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.29 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$35.50 |
$190 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.15 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$35.50 |
$190 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.10 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$35.50 |
$190 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.15 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$35.50 |
$190 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.29 |
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 |
Health Net Seniority Plus Sapphire (HMO)
|
$35.50 |
$240 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.17 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$35.50 |
$240 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.29 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$35.50 |
$240 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.22 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$35.50 |
$240 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.29 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$35.50 |
$240 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.17 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$35.50 |
$240 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.22 |
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 |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$35.50 |
$85 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.15 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$35.50 |
$85 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | n/a | P Q:3 /1Days | $503.15 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | n/a | Q:60 /30Days | $503.18 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$35.50 |
$405 |
to be determined |
2 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $494.65 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
25% | n/a | Q:30 /30Days | $494.65 |
Browse Plan Formulary |
Traditional Plus-LA (HMO)
|
$35.50 |
$405 |
to be determined |
3 |
Preferred Brand |
25% | n/a | Q:60 /30Days | $522.62 |
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 |
Aetna Medicare Choice Plan (PPO)
|
$79.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:60 /30Days | $519.91 |
Browse Plan Formulary |