MONTELUKAST SOD 4 MG GRANULES [Singulair] (30 EA ) (NDC: 27241001531)
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)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $38.21 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $38.21 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $38.21 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $38.21 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days | $50.13 |
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)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days | $50.13 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days | $63.68 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days | $63.68 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Heart & Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | None | $127.20 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Heart & Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | None | $127.20 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | None | $127.04 |
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 |
Alignment Health Plan My Choice (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | None | $127.04 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$3.00 | n/a | None | $127.20 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$3.00 | n/a | None | $127.20 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | n/a | None | $127.20 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | n/a | None | $127.20 |
Browse Plan Formulary |
Anthem Breathe (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Breathe (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
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 |
Anthem Breathe (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Breathe (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem Connect (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Connect (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$405* |
to be determined |
2* |
Generic |
$0.00 | n/a | None | $122.19 |
Browse Plan Formulary |
Anthem Connect (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Connect (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$405* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | n/a | None | $122.19 |
Browse Plan Formulary |
Anthem Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem ESRD (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem ESRD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
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 |
Anthem ESRD (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem ESRD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem Heart (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem Heart (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $122.19 |
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 |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $122.19 |
Browse Plan Formulary |
Anthem StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$14.50 | n/a | None | $119.75 |
Browse Plan Formulary |
Anthem StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$14.50 | n/a | None | $119.75 |
Browse Plan Formulary |
Anthem Touch (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Touch (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$9.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem Touch (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem Touch (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$9.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem Value Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$9.50 | n/a | None | $111.79 |
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 |
Anthem Value Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$9.50 | n/a | None | $111.79 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | Q:30 /30Days | $91.40 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | Q:30 /30Days | $91.40 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | n/a | Q:30 /30Days | $91.40 |
Browse Plan Formulary |
Brand New Day Bridges Drug Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Bridges Drug Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
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)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Care Drug Savings (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Classic Care Drug Savings (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Care Drug Savings (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Embrace Care Drug Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Care Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Embrace Care Drug Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Care Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Harmony Drug Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$9.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Harmony Drug Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$9.00 | n/a | None | $96.17 |
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)
![Email Prescription and/or Health Benefit details for Brand New Day In Control Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day In Control Drug Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day In Control Drug Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$75.00 | n/a | None | $96.17 |
Browse Plan Formulary |
Central Health Focus Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Central Health Focus Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | Q:30 /30Days | $84.71 |
Browse Plan Formulary |
Central Health Focus Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Central Health Focus Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | Q:30 /30Days | $84.71 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Central Health Medi-Medi Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$405* |
to be determined |
2* |
Generic |
$0.00 | n/a | Q:30 /30Days | $82.10 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Medicare Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | Q:30 /30Days | $84.71 |
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 |
Central Health Medicare Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Medicare Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | Q:30 /30Days | $84.71 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Best Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $25.00 | None | $135.18 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Best Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $25.00 | None | $135.18 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Easy Choice Freedom Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
50% | 50% | None | $135.18 |
Browse Plan Formulary |
Golden State Medicare Gold (HMO)
![Email Prescription and/or Health Benefit details for Golden State Medicare Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $144.91 |
Browse Plan Formulary |
Golden State Medicare Gold (HMO)
![Email Prescription and/or Health Benefit details for Golden State Medicare Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $144.91 |
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 |
Golden State Medicare Gold (HMO)
![Email Prescription and/or Health Benefit details for Golden State Medicare Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $126.17 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:30 /30Days | $125.08 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:30 /30Days | $125.08 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
![Email Prescription and/or Health Benefit details for Inter Valley Health Plan Service To Seniors (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | n/a | Q:30 /30Days | $84.71 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | n/a | None | $142.47 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | n/a | None | $142.47 |
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 |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A Care Cal MediConnect 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 | $158.67 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A Care Cal MediConnect 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 | $158.67 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (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 | $135.42 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (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 | $135.42 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
48% | n/a | None | $135.42 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Balance (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$2.00 | n/a | None | $89.46 |
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 |
SCAN Balance (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Balance (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$2.00 | n/a | None | $89.46 |
Browse Plan Formulary |
SCAN Classic (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | None | $90.89 |
Browse Plan Formulary |
SCAN Classic (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | None | $90.89 |
Browse Plan Formulary |
SCAN Classic II (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | None | $90.89 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$405 |
to be determined |
2 |
Generic |
25% | n/a | None | $92.97 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections at Home (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$405 |
to be determined |
2 |
Generic |
25% | n/a | None | $90.89 |
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 |
SCAN Healthy at Home (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Healthy at Home (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | None | $91.36 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Healthy at Home (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | None | $91.36 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$17.00 | n/a | None | $142.47 |
Browse Plan Formulary |
Traditional-LA (HMO)
![Email Prescription and/or Health Benefit details for Traditional-LA (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$5.00 | n/a | Q:30 /30Days | $59.55 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | n/a | None | $142.47 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | n/a | None | $142.47 |
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 |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $129.87 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $129.87 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.30 |
$405 |
to be determined |
2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $50.44 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.30 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $50.44 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Easy Choice Freedom Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.60 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | None | $135.18 |
Browse Plan Formulary |
SCAN Classic II (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | n/a | None | $90.89 |
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 |
AARP MedicareComplete SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$0 |
to be determined |
2 |
Generic |
$9.00 | $0.00 | Q:30 /30Days | $38.21 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$9.00 | $0.00 | Q:30 /30Days | $38.21 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.30 |
$405 |
to be determined |
2 |
Generic |
$20.00 | $50.00 | None | $135.18 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.30 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $50.00 | None | $135.18 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$405 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | n/a | None | $92.97 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$17.00 | n/a | None | $142.47 |
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)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days | $50.13 |
Browse Plan Formulary |
Anthem Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$405 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $119.91 |
Browse Plan Formulary |
Anthem Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | n/a | None | $119.91 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections at Home (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.20 |
$405 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | n/a | None | $90.89 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
2 |
Generic |
$10.00 | n/a | None | $127.17 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | n/a | None | $127.17 |
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 |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $111.79 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | n/a | None | $111.79 |
Browse Plan Formulary |
Brand New Day Bridges Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Bridges Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Classic Choice for Medi-Medi (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Choice for Medi-Medi (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Classic Choice for Medi-Medi (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Choice for Medi-Medi (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
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 Dual Coverage (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Dual Coverage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Dual Coverage (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Dual Coverage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Embrace Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Embrace Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Harmony Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day Harmony Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
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 Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day In Control Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
Browse Plan Formulary |
Brand New Day In Control Choice for Medi-Medi (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day In Control Choice for Medi-Medi (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | n/a | None | $96.17 |
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Central Health Medi-Medi Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Central Health Medi-Medi Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | n/a | Q:30 /30Days | $82.10 |
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Central Health Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405* |
to be determined |
2* |
Generic |
$0.00 | n/a | Q:30 /30Days | $84.71 |
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Central Health Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | n/a | Q:30 /30Days | $84.71 |
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Inter Valley Health Plan Value Preferred Choice (HMO)
![Email Prescription and/or Health Benefit details for Inter Valley Health Plan Value Preferred Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:30 /30Days | $84.71 |
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)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
48% | n/a | None | $135.42 |
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PHP (HMO SNP)
![Email Prescription and/or Health Benefit details for PHP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
1 |
Generic |
25% | n/a | None | $96.02 |
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PHP (HMO SNP)
![Email Prescription and/or Health Benefit details for PHP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
25% | n/a | None | $96.02 |
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SCAN Plus (HMO)
![Email Prescription and/or Health Benefit details for SCAN Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
2 |
Generic |
25% | n/a | None | $92.97 |
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SCAN Plus (HMO)
![Email Prescription and/or Health Benefit details for SCAN Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | n/a | None | $92.97 |
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Traditional Plus-LA (HMO)
![Email Prescription and/or Health Benefit details for Traditional Plus-LA (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
2 |
Generic |
25% | n/a | Q:30 /30Days | $59.55 |
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 |
VillageHealth (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for VillageHealth (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
to be determined |
2 |
Generic |
25% | n/a | None | $89.46 |
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VillageHealth (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for VillageHealth (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | n/a | None | $89.46 |
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Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$79.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:30 /30Days | $50.13 |
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