ALOSETRON HCL 0.5 MG TABLET [Lotronex] (60 TABLETS ) (NDC: 45963047903)
2021 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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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 Medicare Advantage Mosaic Choice (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Mosaic Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | P | $1,244.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Prime (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P | $1,244.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Elite Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
28% | n/a | P Q:60 /30Days | $896.40 |
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 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | P Q:60 /30Days | $919.80 |
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 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $505.20 |
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 |
Bright Advantage Choice (PPO)
![Email Prescription and/or Health Benefit details for Bright Advantage Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $505.20 |
Browse Plan Formulary |
Bright Advantage Senior Savings (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Bright Advantage Senior Savings (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:60 /30Days | $505.20 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Centers Plan for Medicare Advantage Care (HMO)
![Email Prescription and/or Health Benefit details for Centers Plan for Medicare Advantage Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
No |
2* |
Generic |
$15.00 | $37.50 | None | $621.00 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $943.80 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $946.80 |
Browse Plan Formulary |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $954.60 |
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 |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $955.80 |
Browse Plan Formulary |
EmblemHealth VIP Part B Saver (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Part B Saver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $945.00 |
Browse Plan Formulary |
EmblemHealth VIP Reserve (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Reserve (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $946.80 |
Browse Plan Formulary |
Empire MediBlue HealthPlus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue HealthPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:60 /30Days | $824.40 |
Browse Plan Formulary |
Empire MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:60 /30Days | $824.40 |
Browse Plan Formulary |
Healthfirst 65 Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst 65 Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No |
4 |
Non-Preferred Drug |
$100.00 | $100.00 | P Q:60 /30Days | $410.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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 |
Healthfirst Signature (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst Signature (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No |
4 |
Non-Preferred Drug |
$100.00 | $100.00 | P Q:60 /30Days | $410.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
1 |
Tier 1 |
0% | 0% | None | $479.40 |
Browse Plan Formulary |
WellCare Absolute (PPO)
![Email Prescription and/or Health Benefit details for WellCare Absolute (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | P Q:60 /30Days | $266.40 |
Browse Plan Formulary |
WellCare Choice (HMO)
![Email Prescription and/or Health Benefit details for WellCare Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
48% | 48% | P Q:60 /30Days | $294.00 |
Browse Plan Formulary |
WellCare Element (HMO)
![Email Prescription and/or Health Benefit details for WellCare Element (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
48% | 48% | P Q:60 /30Days | $267.60 |
Browse Plan Formulary |
WellCare Today's Options Advantage Plus 550B (PPO)
![Email Prescription and/or Health Benefit details for WellCare Today's Options Advantage Plus 550B (PPO)](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 |
$90.00 | $180.00 | P Q:60 /30Days | $326.40 |
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 Summit (PPO)
![Email Prescription and/or Health Benefit details for WellCare Summit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.10 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $273.00 |
Browse Plan Formulary |
WellCare Compass (HMO)
![Email Prescription and/or Health Benefit details for WellCare Compass (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $267.60 |
Browse Plan Formulary |
WellCare Imperial (PPO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Imperial (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.50 |
$445 |
No |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days | $268.20 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:60 /30Days | $767.40 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:60 /30Days | $784.20 |
Browse Plan Formulary |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:60 /30Days | $991.80 |
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 Medicare Advantage Choice Plan 1 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$300 |
No |
5 |
Specialty Tier |
27% | n/a | P | $1,243.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Fidelis Dual Advantage Flex (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Fidelis Dual Advantage Flex (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.60 |
$445 |
No |
2 |
Generic |
$10.00 | $20.00 | P Q:60 /30Days | $997.80 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
28% | n/a | P Q:60 /30Days | $986.40 |
Browse Plan Formulary |
Fidelis Medicaid Advantage Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Fidelis Medicaid Advantage Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.30 |
$445 |
No |
2 |
Generic |
$7.00 | $14.00 | P Q:60 /30Days | $931.20 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Fidelis Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$445 |
No |
2 |
Generic |
$20.00 | $40.00 | P Q:60 /30Days | $997.80 |
Browse Plan Formulary |
Elderplan Extra Help (HMO)
![Email Prescription and/or Health Benefit details for Elderplan Extra Help (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.30 |
$445 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | P Q:60 /30Days | $1,274.40 |
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 Assure Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.70 |
$190 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $956.40 |
Browse Plan Formulary |
WellCare Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.10 |
$445 |
No |
4 |
Non-Preferred Drug |
45% | 45% | P Q:60 /30Days | $294.00 |
Browse Plan Formulary |
Elderplan Plus Long Term Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Elderplan Plus Long Term Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.80 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days | $1,274.40 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.60 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | P | $1,257.00 |
Browse Plan Formulary |
Bright Advantage Senior Savings Assist (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Bright Advantage Senior Savings Assist (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.90 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:60 /30Days | $505.20 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
AARP Medicare Advantage Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$395 |
No |
5 |
Specialty Tier |
25% | n/a | P | $1,243.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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 |
Elderplan For Medicaid Beneficiaries (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Elderplan For Medicaid Beneficiaries (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.40 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days | $1,274.40 |
Browse Plan Formulary |
Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Elderplan Advantage For Nursing Home Residents (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | P Q:60 /30Days | $1,274.40 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.60 |
$275 |
No |
5 |
Specialty Tier |
28% | n/a | P | $1,243.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | P | $1,258.80 |
Browse Plan Formulary |
Aetna Medicare Elite Plan 3 (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite Plan 3 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $986.40 |
Browse Plan Formulary |
AgeWell New York Advantage Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York Advantage Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | None | $1,188.60 |
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 |
AgeWell New York CareWell (HMO I-SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York CareWell (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | None | $1,196.40 |
Browse Plan Formulary |
AgeWell New York FeelWell (HMO D-SNP)
![Email Prescription and/or Health Benefit details for AgeWell New York FeelWell (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | None | $1,188.60 |
Browse Plan Formulary |
AgeWell New York LiveWell (HMO)
![Email Prescription and/or Health Benefit details for AgeWell New York LiveWell (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$350 |
No |
5 |
Specialty Tier |
26% | 26% | None | $1,188.60 |
Browse Plan Formulary |
ArchCare Advantage (HMO I-SNP)
![Email Prescription and/or Health Benefit details for ArchCare Advantage (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | P Q:60 /30Days | $1,227.00 |
Browse Plan Formulary |
Bright Advantage Assist (HMO)
![Email Prescription and/or Health Benefit details for Bright Advantage Assist (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $505.20 |
Browse Plan Formulary |
Bright Advantage Special Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Bright Advantage Special Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $505.20 |
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 |
Centers Plan for Dual Coverage Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Dual Coverage Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | None | $715.80 |
Browse Plan Formulary |
Centers Plan for Nursing Home Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Nursing Home Care (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | None | $653.40 |
Browse Plan Formulary |
Elderplan Assist (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Elderplan Assist (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $1,274.40 |
Browse Plan Formulary |
EmblemHealth VIP Assist (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Assist (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $946.20 |
Browse Plan Formulary |
EmblemHealth VIP Connect (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Connect (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $946.20 |
Browse Plan Formulary |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $943.80 |
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 |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $955.80 |
Browse Plan Formulary |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $946.80 |
Browse Plan Formulary |
EmblemHealth VIP Dual Reserve (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual Reserve (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $946.80 |
Browse Plan Formulary |
EmblemHealth VIP Dual Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:60 /30Days | $948.00 |
Browse Plan Formulary |
EmblemHealth VIP Passport NYC (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Passport NYC (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $946.80 |
Browse Plan Formulary |
EmblemHealth VIP Solutions (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Solutions (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | P Q:60 /30Days | $945.00 |
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 |
Empire MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $817.20 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue Dual Advantage Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $814.20 |
Browse Plan Formulary |
Empire MediBlue Extra Select (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Extra Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $824.40 |
Browse Plan Formulary |
Empire MediBlue HealthPlus Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue HealthPlus Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $814.20 |
Browse Plan Formulary |
Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $814.20 |
Browse Plan Formulary |
Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $814.20 |
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 |
Hamaspik Medicare Choice (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Hamaspik Medicare Choice (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P | $568.80 |
Browse Plan Formulary |
Hamaspik Medicare Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Hamaspik Medicare Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P | $648.60 |
Browse Plan Formulary |
Healthfirst CompleteCare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Healthfirst CompleteCare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:60 /30Days | $411.60 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst Increased Benefits Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | P Q:60 /30Days | $411.60 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Healthfirst Life Improvement Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:60 /30Days | $411.60 |
Browse Plan Formulary |
Integra Balanced Medicaid Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Integra Balanced Medicaid Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $1,233.60 |
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 |
Integra Harmony (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Integra Harmony (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $1,233.60 |
Browse Plan Formulary |
Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $1,233.60 |
Browse Plan Formulary |
Longevity Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Longevity Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | None | $325.80 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for MetroPlus Advantage Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days | $1,321.20 |
Browse Plan Formulary |
MetroPlus UltraCare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for MetroPlus UltraCare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:60 /30Days | $1,321.20 |
Browse Plan Formulary |
RiverSpring MAP (HMO D-SNP)
![Email Prescription and/or Health Benefit details for RiverSpring MAP (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P | $1,012.80 |
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 |
RiverSpring Star (HMO I-SNP)
![Email Prescription and/or Health Benefit details for RiverSpring Star (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | P | $1,012.80 |
Browse Plan Formulary |
Senior Whole Health of New York NHC (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health of New York NHC (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | None | $962.40 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Assisted Living Plan (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P | $1,242.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Dual Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P | $1,243.80 |
Browse Plan Formulary |
VillageCareMAX Medicare Health Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VillageCareMAX Medicare Health Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | None | $479.40 |
Browse Plan Formulary |
VNSNY CHOICE Total (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VNSNY CHOICE Total (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$445 |
No |
2 |
Generic |
$19.00 | $57.00 | None | $552.60 |
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 |
UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.70 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P | $1,243.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.00 |
$395 |
No |
5 |
Specialty Tier |
25% | n/a | P | $1,243.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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) |
$59.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $505.20 |
Browse Plan Formulary |
EmblemHealth VIP Go (HMO-POS)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Go (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | P Q:60 /30Days | $955.80 |
Browse Plan Formulary |
EmblemHealth VIP Go (HMO-POS)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Go (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | P Q:60 /30Days | $945.00 |
Browse Plan Formulary |
WellCare Preferred (HMO)
![Email Prescription and/or Health Benefit details for WellCare Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$81.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | P Q:60 /30Days | $267.00 |
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 |
Bright Advantage Choice Plus (PPO)
![Email Prescription and/or Health Benefit details for Bright Advantage Choice Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$95.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $505.20 |
Browse Plan Formulary |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$96.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $954.60 |
Browse Plan Formulary |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$96.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $955.80 |
Browse Plan Formulary |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$96.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $943.80 |
Browse Plan Formulary |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$96.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $946.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $900.00 |
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 |
Centers Plan for Medicaid Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Medicaid Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$101.00 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | None | $715.80 |
Browse Plan Formulary |
Centers Plan for Medicaid Advantage Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Medicaid Advantage Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$101.00 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | None | $646.80 |
Browse Plan Formulary |
Empire MediBlue Choice (HMO-POS)
![Email Prescription and/or Health Benefit details for Empire MediBlue Choice (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$105.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:60 /30Days | $767.40 |
Browse Plan Formulary |
VillageCareMAX Medicare Total Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VillageCareMAX Medicare Total Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$116.00 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | None | $479.40 |
Browse Plan Formulary |
MetroPlus Platinum Plan (HMO)
![Email Prescription and/or Health Benefit details for MetroPlus Platinum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$148.50 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | P Q:60 /30Days | $1,321.20 |
Browse Plan Formulary |
EmblemHealth VIP Gold Plus (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$302.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $948.00 |
Browse Plan Formulary |