PULMOZYME 1MG/ML AMPUL (5 (6X POUCH) CRTN) (NDC: 50242010040)
2019 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 |
AARP MedicareComplete Choice (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | 30% | P Q:150 /30Days | $3,644.82 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$395 | to be determined | 5 |
Specialty Tier |
25% | 25% | P Q:150 /30Days | $3,598.21 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (HMO-POS)
|
$0.00 |
$195 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
29% | n/a | P | $3,624.01 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$295 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
27% | n/a | P | $3,624.01 |
Browse Plan Formulary |
Allwell Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,527.62 |
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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,462.15 |
Browse Plan Formulary |
AvMed Medicare Circle (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,403.44 |
Browse Plan Formulary |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,453.03 |
Browse Plan Formulary |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,460.10 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
31% | n/a | P | $3,620.50 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,620.50 |
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 |
Coventry Medicare Summit Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,641.53 |
Browse Plan Formulary |
Devoted Health Broward (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,403.53 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Specialty Tier |
33% | n/a | P | $3,580.99 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Specialty Tier |
33% | n/a | P | $3,580.99 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Specialty Tier |
33% | n/a | P | $3,580.99 |
Browse Plan Formulary |
HealthSun HealthAdvantage Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,524.79 |
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 |
Humana Gold Plus - Diabetes (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,620.50 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,620.50 |
Browse Plan Formulary |
Humana Gold Plus H1036-237 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $3,620.50 |
Browse Plan Formulary |
Humana Gold Plus H1036-237 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $3,513.17 |
Browse Plan Formulary |
HumanaChoice Florida H5216-068 (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
30% | n/a | P | $3,620.50 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$395 | to be determined | 5 |
Specialty Tier |
25% | n/a | P | $3,620.50 |
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 |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | 33% | P Q:150 /30Days | $3,600.14 |
Browse Plan Formulary |
MMM - ELITE (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,382.84 |
Browse Plan Formulary |
MMM - EXTRA (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P | $3,382.84 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Specialty Tier |
33% | n/a | P | $3,580.99 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Specialty Tier |
33% | n/a | P | $3,580.99 |
Browse Plan Formulary |
PHP (HMO SNP)
|
$0.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $3,347.53 |
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 |
Preferred Choice Broward (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | 33% | P Q:150 /30Days | $3,600.14 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,355.93 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,355.93 |
Browse Plan Formulary |
Solis Health Plans (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P | $3,520.71 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP ONE (Regional PPO SNP)
|
$0.00 |
$415 | to be determined | 5 |
All Formulary Drugs |
$0.00 | $0.00 | P Q:150 /30Days | $3,598.21 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,738.94 |
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 |
WellCare Dividend (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,483.97 |
Browse Plan Formulary |
WellCare Dividend Prime (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,483.97 |
Browse Plan Formulary |
WellCare Elite (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,483.97 |
Browse Plan Formulary |
WellCare Premier (PPO)
|
$0.00 |
$100 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
31% | n/a | P | $3,483.97 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $3,483.97 |
Browse Plan Formulary |
CareExtra (HMO)
|
$11.90 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,620.50 |
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 |
CareNeeds PLUS (HMO SNP)
|
$18.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,620.50 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$18.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,620.50 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$22.20 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,620.50 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-255 (HMO SNP)
|
$23.10 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,620.50 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.80 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,483.97 |
Browse Plan Formulary |
WellCare Reserve (HMO SNP)
|
$25.00 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,483.97 |
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 RP (Regional PPO SNP)
|
$25.30 |
$415 | to be determined | 5 |
All Formulary Drugs |
15% | 15% | P Q:150 /30Days | $3,598.21 |
Browse Plan Formulary |
Coventry Medicare Summit Plan (HMO SNP)
|
$25.50 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,641.55 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$26.60 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,483.97 |
Browse Plan Formulary |
WellCare Select (HMO SNP)
|
$26.80 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,483.97 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO SNP)
|
$27.00 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | 25% | P Q:150 /30Days | $3,644.82 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO SNP)
|
$27.70 |
$200 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
29% | 29% | P Q:150 /30Days | $3,570.60 |
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)
|
$30.20 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,403.53 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO SNP)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,403.53 |
Browse Plan Formulary |
BlueMedicare Complete (HMO SNP)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,460.12 |
Browse Plan Formulary |
Devoted Health Prime Broward (HMO)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,403.53 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$30.30 |
$415 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $3,580.99 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$30.30 |
$415 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $3,580.99 |
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 |
HealthSun MediMax (HMO)
|
$30.30 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,520.53 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO SNP)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | 25% | P Q:150 /30Days | $3,644.82 |
Browse Plan Formulary |
MMM - PLATINUM (HMO SNP)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,403.53 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$30.30 |
$415 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $3,580.99 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$30.30 |
$415 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $3,580.99 |
Browse Plan Formulary |
Simply Advantage (HMO SNP)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,355.94 |
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 |
Simply Care (HMO SNP)
|
$30.30 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | n/a | P | $3,355.93 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,355.93 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,355.94 |
Browse Plan Formulary |
Simply Select (HMO)
|
$30.30 |
$415 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
25% | n/a | P | $3,355.93 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$30.30 |
$415 | No additional gap coverage, only the Donut Hole Discount | 5 |
All Formulary Drugs |
25% | 25% | P Q:150 /30Days | $3,598.21 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$31.30 |
$100 | to be determined | 5 |
Specialty Tier |
31% | n/a | P | $3,620.50 |
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 |
BlueMedicare Choice (Regional PPO)
|
$41.00 |
$250 | to be determined | 5 |
Specialty Tier |
28% | n/a | P | $3,520.71 |
Browse Plan Formulary |
HumanaChoice H5216-065 (PPO)
|
$57.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
26% | n/a | P | $3,620.50 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$117.00 |
$200 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
29% | n/a | P | $3,620.50 |
Browse Plan Formulary |
BlueMedicare Select (PPO)
|
$147.80 |
$305 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
27% | n/a | P | $3,467.24 |
Browse Plan Formulary |