METFORMIN HCL 850 MG TABLET (500 EA ) (NDC: 65862000905)
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 6 (HMO)
|
$0.00 |
$225* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | Q:90 /30Days | $7.56 |
Browse Plan Formulary |
Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | Q:90 /30Days | $11.07 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | None | $7.54 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$145* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | None | $6.39 |
Browse Plan Formulary |
Allwell Medicare (HMO)
|
$0.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $2.93 |
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 |
Anthem MediBlue Essential (HMO)
|
$0.00 |
$60* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.50 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.48 |
Browse Plan Formulary |
Bright Advantage (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $8.00 | Q:90 /30Days | $7.15 |
Browse Plan Formulary |
Bright Advantage Flex (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $8.00 | Q:90 /30Days | $7.15 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
|
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$6.00 | $0.00 | Q:90 /30Days | $4.14 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO SNP)
|
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$7.00 | $0.00 | None | $3.19 |
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 |
Humana Gold Plus H6622-021 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | None | $3.17 |
Browse Plan Formulary |
Humana Gold Plus H6622-021 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | None | $3.16 |
Browse Plan Formulary |
HumanaChoice H5525-042 (PPO)
|
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | None | $3.31 |
Browse Plan Formulary |
MediGold Southwest OH Essential Care (HMO)
|
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $4.00 | Q:90 /30Days | $2.94 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $6.81 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.23 |
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 |
MeridianCare Enhanced (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $8.00 | Q:90 /30Days | $37.34 |
Browse Plan Formulary |
MeridianCare Essential (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $37.34 |
Browse Plan Formulary |
MeridianCare Essential Smile (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $37.34 |
Browse Plan Formulary |
Molina Dual Options ? MyCareOhio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | Q:90 /30Days | $4.27 |
Browse Plan Formulary |
Mutual of Omaha CareAdvantage Complete (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:90 /30Days | $7.80 |
Browse Plan Formulary |
Humana Gold Plus H6622-055 (HMO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.26 |
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 H5216-109 (PPO)
|
$19.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $0.00 | None | $3.27 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold 2 (Regional PPO)
|
$21.50 |
$350* |
to be determined |
1* |
Preferred Generic |
$2.00 | $0.00 | None | $6.39 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$25.60 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
15% | 15% | Q:90 /30Days | $7.47 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
|
$26.40 |
$395* |
to be determined |
1* |
Preferred Generic |
$9.00 | $0.00 | None | $3.31 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$28.00 |
$170* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:90 /30Days | $7.55 |
Browse Plan Formulary |
Mutual of Omaha CareAdvantage Plus (HMO)
|
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.91 |
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 |
Humana Gold Plus SNP-DE H6622-015 (HMO SNP)
|
$31.20 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.21 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO SNP)
|
$32.90 |
$50* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $2.83 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO SNP)
|
$32.90 |
$415* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.48 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$32.90 |
$415* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.48 |
Browse Plan Formulary |
CareSource Advantage (HMO)
|
$32.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | $10.00 | Q:90 /30Days | $4.14 |
Browse Plan Formulary |
MeridianCare Extra (HMO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | Q:90 /30Days | $37.34 |
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 |
MeridianCare Extra Smile (HMO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | Q:90 /30Days | $37.34 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
25% | 25% | Q:90 /30Days | $7.40 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
|
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
25% | 25% | Q:90 /30Days | $7.58 |
Browse Plan Formulary |
Bright Advantage Plus (HMO)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.15 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $6.81 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$38.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.23 |
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)
|
$38.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $6.81 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$160* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.23 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold (Regional PPO)
|
$53.30 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.39 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$56.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.30 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$56.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.55 |
Browse Plan Formulary |
Bright Advantage Flex Plus (PPO)
|
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.15 |
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 H5216-023 (PPO)
|
$57.00 |
$175* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | None | $3.31 |
Browse Plan Formulary |
MediGold Flexible Choice (PPO)
|
$57.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$2.00 | $4.00 | Q:90 /30Days | $2.94 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
|
$57.80 |
$200* |
to be determined |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.48 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$63.00 |
$60* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days | $6.91 |
Browse Plan Formulary |
CareSource Advantage Plus (HMO)
|
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $4.14 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $6.81 |
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 Preferred (PPO)
|
$74.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.23 |
Browse Plan Formulary |
Humana Gold Plus H6622-019 (HMO)
|
$87.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $0.00 | None | $3.24 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$98.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$2.00 | $0.00 | None | $6.77 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $6.81 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$99.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.23 |
Browse Plan Formulary |
Humana Gold Choice H8145-032 (PFFS)
|
$103.00 |
$225* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$7.00 | $0.00 | None | $3.30 |
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 Plan 3 (HMO)
|
$111.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.56 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $6.81 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$119.00 |
$55* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $7.23 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$2.00 | $0.00 | None | $6.72 |
Browse Plan Formulary |
MediGold Southwest OH Classic Preferred (HMO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $2.94 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
|
$155.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$1.00 | $0.00 | None | $3.31 |
Browse Plan Formulary |