ATORVASTATIN 10 MG TABLET [Lipitor] (1000.000 EA ) (NDC: 60505257808)
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. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $5.65 |
Browse Plan Formulary |
BlueJourney Essential (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $12.88 |
Browse Plan Formulary |
Cigna-HealthSpring PreventiveCare (HMO)
|
$0.00 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | n/a | Q:30 /30Days | $11.24 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.52 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.53 |
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 HMO Signature (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.74 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
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. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
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. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Health Partners Medicare Value (HMO)
|
$0.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$4.00 | n/a | Q:60 /30Days | $10.19 |
Browse Plan Formulary |
Humana Gold Plus H6622-035 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $0.00 | Q:30 /30Days | $4.75 |
Browse Plan Formulary |
Humana Gold Plus H6622-043 (HMO)
|
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$19.00 | $0.00 | Q:30 /30Days | $4.70 |
Browse Plan Formulary |
Vibra Health Plan Essential Coverage (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$0.00 | n/a | Q:45 /30Days | $4.80 |
Browse Plan Formulary |
AdvantraOne (PPO)
|
$19.00 |
$195* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $6.02 |
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 |
1 |
Tier 1 |
$0.00 | n/a | Q:30 /30Days | $8.86 |
Browse Plan Formulary |
UPMC for Life HMO Deductible with Rx (HMO)
|
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | n/a | None | $10.58 |
Browse Plan Formulary |
BlueJourney Alliance Heart and Diabetes Care (HMO SNP)
|
$23.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $12.88 |
Browse Plan Formulary |
Cigna-HealthSpring Preferred (HMO)
|
$23.00 |
$280* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | n/a | Q:30 /30Days | $11.24 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$23.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.53 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$23.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.63 |
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)
|
$23.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.76 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete ONE (HMO SNP)
|
$23.50 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:30 /30Days | $8.86 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 1 (PPO)
|
$24.00 |
$130* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $9.00 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H6622-038 (HMO SNP)
|
$25.00 |
$230* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $4.68 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO SNP)
|
$29.30 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $8.83 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.40 |
$315* |
to be determined |
1* |
Preferred Generic |
$10.00 | $0.00 | Q:30 /30Days | $4.86 |
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 |
Cigna-HealthSpring TotalCare (HMO SNP)
|
$29.90 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:30 /30Days | $11.24 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$32.70 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:30 /30Days | $8.91 |
Browse Plan Formulary |
BlueJourney Alliance Lung Care (HMO SNP)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $12.88 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$35.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | n/a | None | $10.58 |
Browse Plan Formulary |
Advantra Silver Plus (HMO)
|
$36.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $5.65 |
Browse Plan Formulary |
Health Partners Medicare Prime (HMO)
|
$37.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | n/a | Q:60 /30Days | $10.19 |
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 |
Health Partners Medicare Special (HMO SNP)
|
$37.00 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | n/a | Q:60 /30Days | $11.09 |
Browse Plan Formulary |
HumanaChoice H5525-006 (PPO)
|
$37.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $0.00 | Q:30 /30Days | $4.67 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO SNP)
|
$37.20 |
$405 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$19.00 | n/a | None | $3.68 |
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 | None | $8.01 |
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 | None | $8.01 |
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 | Q:45 /30Days | $3.68 |
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 Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
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 |
BlueJourney Value (HMO)
|
$48.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $12.00 | None | $12.88 |
Browse Plan Formulary |
Vibra Health Plan Enhanced Coverage (PPO)
|
$55.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$0.00 | n/a | Q:45 /30Days | $4.80 |
Browse Plan Formulary |
Aetna Medicare Silver Plan (HMO)
|
$56.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $6.01 |
Browse Plan Formulary |
Cigna-HealthSpring Achieve (HMO SNP)
|
$58.00 |
$280* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | n/a | Q:30 /30Days | $11.24 |
Browse Plan Formulary |
BlueJourney Classic (PPO)
|
$62.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $12.88 |
Browse Plan Formulary |
Humana Gold Choice H8145-052 (PFFS)
|
$63.00 |
$360* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | Q:30 /30Days | $4.76 |
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 Choice Plan 2 (PPO)
|
$64.00 |
$110* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $9.00 |
Browse Plan Formulary |
Freedom Blue PPO ValueRx (PPO)
|
$73.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.61 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
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)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$81.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | n/a | None | $10.58 |
Browse Plan Formulary |
Advantra Silver Plus (PPO)
|
$86.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $5.69 |
Browse Plan Formulary |
HumanaChoice H5216-120 (PPO)
|
$117.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days | $4.67 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$126.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $5.52 |
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 |
Advantra Gold (PPO)
|
$136.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $5.67 |
Browse Plan Formulary |
Cigna-HealthSpring Preferred Plus (HMO)
|
$139.00 |
$280* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | n/a | Q:30 /30Days | $11.24 |
Browse Plan Formulary |
BlueJourney Premier (HMO)
|
$148.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $12.88 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
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 Classic Advantage Rx (HMO)
|
$154.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$154.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | n/a | Q:45 /30Days | $3.68 |
Browse Plan Formulary |
Aetna Medicare Gold Plan (PPO)
|
$156.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $6.02 |
Browse Plan Formulary |
BlueJourney Prime (PPO)
|
$169.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $12.88 |
Browse Plan Formulary |
Freedom Blue PPO Standard (PPO)
|
$188.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.61 |
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 Deluxe (PPO)
|
$291.50 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.61 |
Browse Plan Formulary |