NEVIRAPINE 50 MG/5 ML SUSP Oral Suspension [Viramune] (mls ) (NDC: 65862005724)
2019 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 Plan 7 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 7 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1800 /30Days | $139.24 |
Browse Plan Formulary |
Advantra Silver (PPO)
![Email Prescription and/or Health Benefit details for Advantra Silver (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $163.80 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $163.80 |
Browse Plan Formulary |
Allwell Medicare (HMO)
![Email Prescription and/or Health Benefit details for Allwell Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$9.00 | $27.00 | None | $162.48 |
Browse Plan Formulary |
Anthem MediBlue Essential (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$60 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:1200 /30Days | $122.85 |
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 Preferred (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Preferred (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 | $190.00 | Q:1200 /30Days | $122.85 |
Browse Plan Formulary |
Bright Advantage (HMO)
![Email Prescription and/or Health Benefit details for Bright Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $157.95 |
Browse Plan Formulary |
Bright Advantage Flex (PPO)
![Email Prescription and/or Health Benefit details for Bright Advantage Flex (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $157.95 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage Zero Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $37.50 | None | $157.30 |
Browse Plan Formulary |
CareSource MyCare Ohio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for CareSource MyCare Ohio (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% | 0% | None | $157.30 |
Browse Plan Formulary |
Humana Gold Plus H6622-014 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-014 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days | $168.66 |
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 |
HumanaChoice H5525-042 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-042 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days | $168.66 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | None | $124.93 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | None | $124.93 |
Browse Plan Formulary |
PrimeTime Health Plan Aultimate (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Aultimate (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $124.55 |
Browse Plan Formulary |
SummaCare Medicare Topaz (HMO)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Topaz (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $133.94 |
Browse Plan Formulary |
The Health Plan SecureCare - Option IV (HMO)
![Email Prescription and/or Health Benefit details for The Health Plan SecureCare - Option IV (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | None | $124.97 |
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 Connected for MyCareOhio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Connected for MyCareOhio (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% | 0% | Q:1800 /30Days | $139.24 |
Browse Plan Formulary |
HumanaChoice H5216-106 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-106 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days | $168.66 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.00 |
$170 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:1800 /30Days | $139.24 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare OH Connect Gold 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$350 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $163.80 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.60 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
All Formulary Drugs |
15% | 15% | Q:1800 /30Days | $139.24 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5495-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.40 |
$395 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days | $168.66 |
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 |
Humana Gold Plus SNP-DE H6622-015 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H6622-015 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.20 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days | $168.66 |
Browse Plan Formulary |
Aetna Better Health of Ohio Dual Preferred (HMO SNP)
![Email Prescription and/or Health Benefit details for Aetna Better Health of Ohio Dual Preferred (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $163.63 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.60 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
All Formulary Drugs |
25% | 25% | Q:1800 /30Days | $139.24 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO SNP)
![Email Prescription and/or Health Benefit details for Allwell Dual Medicare (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$50 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $156.77 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Dual Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:1200 /30Days | $122.85 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:1200 /30Days | $122.85 |
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 |
CareSource Advantage (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $25.00 | None | $157.30 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 2 (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
4 |
All Formulary Drugs |
25% | 25% | Q:1800 /30Days | $139.24 |
Browse Plan Formulary |
Bright Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Bright Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $157.95 |
Browse Plan Formulary |
The Health Plan SecureCare SNP (HMO SNP)
![Email Prescription and/or Health Benefit details for The Health Plan SecureCare SNP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.70 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
All Formulary Drugs |
15% | 15% | None | $124.48 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
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 |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | None | $124.93 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $35.00 | None | $124.93 |
Browse Plan Formulary |
PrimeTime Health Plan Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $124.55 |
Browse Plan Formulary |
HumanaChoice H5216-051 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-051 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days | $168.66 |
Browse Plan Formulary |
SummaCare Medicare Ruby (HMO)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Ruby (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $133.94 |
Browse Plan Formulary |
The Health Plan SecureCare - Option II (HMO)
![Email Prescription and/or Health Benefit details for The Health Plan SecureCare - Option II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | None | $124.97 |
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 |
Aetna Medicare OH Connect Gold (Regional PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare OH Connect Gold (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.30 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $163.80 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:1200 /30Days | $122.85 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:1200 /30Days | $122.85 |
Browse Plan Formulary |
Bright Advantage Flex Plus (PPO)
![Email Prescription and/or Health Benefit details for Bright Advantage Flex Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $157.95 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access Basic (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.80 |
$200 |
to be determined |
4 |
Non-Preferred Drug |
41% | 41% | Q:1200 /30Days | $122.85 |
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) |
$63.00 |
$60 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:1200 /30Days | $122.85 |
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 |
The Health Plan SecureChoice - Option II (PPO)
![Email Prescription and/or Health Benefit details for The Health Plan SecureChoice - Option II (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$66.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | None | $124.97 |
Browse Plan Formulary |
CareSource Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $25.00 | None | $157.30 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
Browse Plan Formulary |
SummaCare Medicare Sapphire (HMO-POS)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Sapphire (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $133.94 |
Browse Plan Formulary |
Anthem MediBlue Access Plus (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$87.00 |
$40 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:1200 /30Days | $122.85 |
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 H6622-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$87.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | Q:1200 /30Days | $168.66 |
Browse Plan Formulary |
PrimeTime Health Plan Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PrimeTime Health Plan Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$89.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $124.55 |
Browse Plan Formulary |
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) |
$98.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $163.80 |
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MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
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MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
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Humana Gold Choice H8145-032 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-032 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$103.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days | $168.66 |
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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 Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$111.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:1800 /30Days | $139.24 |
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MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $22.00 | None | $124.93 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $163.80 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-030 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$155.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | Q:1200 /30Days | $168.66 |
Browse Plan Formulary |
SummaCare Medicare Emerald (HMO-POS)
![Email Prescription and/or Health Benefit details for SummaCare Medicare Emerald (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$180.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $133.94 |
Browse Plan Formulary |