REXULTI 0.25 MG TABLET (30 EA ) (NDC: 59148003513)
2018 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
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 |
Advantra Silver (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,132.44 |
Browse Plan Formulary |
BlueJourney Essential (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,102.66 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
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 |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,087.77 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
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 |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,087.77 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Vibra Health Plan Essential Coverage (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,121.33 |
Browse Plan Formulary |
AARP MedicareComplete (HMO)
|
$14.00 |
$230 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
28% | 28% | Q:30 /30Days | $1,197.12 |
Browse Plan Formulary |
AdvantraOne (PPO)
|
$19.00 |
$195 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
29% | n/a | Q:360 /30Days | $1,132.13 |
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 |
UnitedHealthcare Dual Complete (HMO SNP)
|
$19.00 |
$405 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | n/a | Q:30 /30Days | $1,190.24 |
Browse Plan Formulary |
UPMC for Life HMO Deductible with Rx (HMO)
|
$20.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $1,090.67 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete ONE (HMO SNP)
|
$23.50 |
$405 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | n/a | Q:30 /30Days | $1,190.24 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 1 (PPO)
|
$24.00 |
$130 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | 30% | Q:30 /30Days | $1,197.12 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$27.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,130.77 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$27.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,110.05 |
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 |
Community Blue Medicare PPO Signature (PPO)
|
$27.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,130.77 |
Browse Plan Formulary |
Humana Value Plus H5216-117 (PPO)
|
$27.40 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
26% | n/a | P Q:30 /30Days | $1,104.38 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO SNP)
|
$29.30 |
$200 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
29% | 29% | Q:30 /30Days | $1,195.92 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.40 |
$315 | to be determined | 5 |
Specialty Tier |
26% | n/a | P Q:30 /30Days | $1,104.67 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$32.70 |
$405 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | Q:30 /30Days | $1,195.36 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$35.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $1,090.67 |
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 |
Advantra Silver Plus (HMO)
|
$36.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
31% | n/a | Q:360 /30Days | $1,132.44 |
Browse Plan Formulary |
HumanaChoice H5525-006 (PPO)
|
$37.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,104.67 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO SNP)
|
$37.20 |
$405 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,096.30 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO SNP)
|
$37.20 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | n/a | P Q:120 /30Days | $1,092.20 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO SNP)
|
$37.20 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | P Q:120 /30Days | $1,092.20 |
Browse Plan Formulary |
Geisinger Gold Secure Rx (HMO SNP)
|
$37.20 |
$405 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | P Q:30 /30Days | $1,087.77 |
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 |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,087.77 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
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 |
BlueJourney Value (HMO)
|
$48.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,102.66 |
Browse Plan Formulary |
Vibra Health Plan Enhanced Coverage (PPO)
|
$55.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,121.33 |
Browse Plan Formulary |
Aetna Medicare Silver Plan (HMO)
|
$56.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,132.42 |
Browse Plan Formulary |
BlueJourney Classic (PPO)
|
$62.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,102.66 |
Browse Plan Formulary |
Humana Gold Choice H8145-052 (PFFS)
|
$63.00 |
$360 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,127.51 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (PPO)
|
$64.00 |
$110 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | 30% | Q:30 /30Days | $1,197.12 |
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 |
Freedom Blue PPO ValueRx (PPO)
|
$73.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,110.05 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$81.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $1,090.67 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$82.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$82.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$82.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$82.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
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 |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$82.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,087.77 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$82.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,106.68 |
Browse Plan Formulary |
Advantra Silver Plus (PPO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,132.44 |
Browse Plan Formulary |
HumanaChoice H5216-120 (PPO)
|
$117.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,104.67 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,132.44 |
Browse Plan Formulary |
BlueJourney Premier (HMO)
|
$148.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,102.66 |
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 Gold Plan (PPO)
|
$156.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,132.42 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$157.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$157.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$157.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,087.77 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$157.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$157.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
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 |
Geisinger Gold Classic Advantage Rx (HMO)
|
$157.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,094.05 |
Browse Plan Formulary |
BlueJourney Prime (PPO)
|
$169.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | Q:360 /30Days | $1,102.66 |
Browse Plan Formulary |
Freedom Blue PPO Standard (PPO)
|
$188.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,110.05 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$291.50 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:31 /31Days | $1,110.05 |
Browse Plan Formulary |