APTIOM 200 MG TABLET (30 EA ) (NDC: 63402020230)
2021 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 Medicare Advantage (HMO-POS)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,134.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice (PPO)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,134.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice Plan 2 (Regional PPO)
|
$0.00 |
$395 |
No |
5 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,133.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Focus (HMO-POS)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,134.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | None | $1,085.40 |
Browse Plan Formulary select insulin pay $10 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 |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | None | $1,085.40 |
Browse Plan Formulary select insulin pay $10 copay but not this drug |
Aetna Medicare Choice (HMO-POS)
|
$0.00 |
$195 |
No |
5 |
Specialty Tier |
29% | n/a | None | $1,120.80 |
Browse Plan Formulary |
Aetna Medicare Premier (PPO)
|
$0.00 |
$300 |
No |
5 |
Specialty Tier |
27% | n/a | None | $1,121.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
30% | n/a | None | $1,122.60 |
Browse Plan Formulary |
Aetna Medicare Select (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,122.60 |
Browse Plan Formulary select insulin pay $20 copay but not this drug |
Align Connect (HMO C-SNP)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Brand |
$95.00 | n/a | P | $1,059.60 |
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 |
Align Thrive (HMO I-SNP)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Brand |
$95.00 | n/a | P | $1,059.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BayCarePlus Complete (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,032.30 |
Browse Plan Formulary |
BayCarePlus Rewards (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,032.30 |
Browse Plan Formulary |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,068.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,072.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Saver (HMO)
|
$0.00 |
$50 |
No |
5 |
Specialty Tier |
32% | n/a | None | $1,074.30 |
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 |
BlueMedicare Value (PPO)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | None | $1,079.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
CareComplete (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,119.00 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareFree (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,122.90 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareFree (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,116.30 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareOne PLATINUM (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,122.90 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,122.90 |
Browse Plan Formulary select insulin pay $20-$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 |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,116.30 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:180 /30Days | $1,104.30 |
Browse Plan Formulary |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:180 /30Days | $1,104.30 |
Browse Plan Formulary |
Devoted Health Core Greater Tampa Bay (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,043.10 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Devoted Health Essentials Greater Tampa Bay (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,043.10 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
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 VIP Care (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom VIP Savings (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary select insulin pay $0-$10 copay but not this drug |
Freedom VIP Savings COPD (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,124.10 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Humana Gold Plus H1036-025 (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,122.60 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Humana Gold Plus H1036-265 (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,124.70 |
Browse Plan Formulary select insulin pay $20-$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 |
Humana Gold Plus H1036-265 (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,122.60 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
HumanaChoice Florida H5216-072 (PPO)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:30 /30Days | $1,119.90 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$395 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,123.80 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary select insulin pay $0-$10 copay but not this drug |
Optimum Diamond Rewards COPD (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
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 |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Premier by Ultimate (HMO)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | None | $1,085.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Premier Plus by Ultimate (HMO)
|
$0.00 |
$0 |
No |
4 |
Specialty Tier |
33% | n/a | None | $1,085.40 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $1,034.10 |
Browse Plan Formulary |
SOLIS SPF 009 (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$85.00 | n/a | P | $1,059.30 |
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 |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,084.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,107.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,100.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,130.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
WellCare Champion (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,123.20 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
WellCare Dividend Prime (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,123.20 |
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 |
WellCare Elite (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,123.20 |
Browse Plan Formulary |
WellCare Guardian (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,123.20 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
WellCare Premier (PPO)
|
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | Q:60 /30Days | $1,123.20 |
Browse Plan Formulary |
CareNeeds PLUS (HMO D-SNP)
|
$14.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,119.00 |
Browse Plan Formulary |
Cigna Primary Medicare (HMO)
|
$17.90 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:180 /30Days | $1,104.30 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
|
$18.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:180 /30Days | $1,104.30 |
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 |
Humana Fully Integrated H1036-283 (HMO D-SNP)
|
$19.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,120.50 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP)
|
$24.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,125.30 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO D-SNP)
|
$25.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,122.90 |
Browse Plan Formulary |
Aetna Medicare Assure Plus (HMO D-SNP)
|
$28.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | None | $1,122.60 |
Browse Plan Formulary |
BayCarePlus Signature (HMO)
|
$28.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,032.30 |
Browse Plan Formulary |
WellCare Access (HMO D-SNP)
|
$28.10 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,122.90 |
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 Reserve (HMO D-SNP)
|
$28.60 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,123.20 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
|
$29.40 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,123.20 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
|
$29.40 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,122.60 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
|
$29.40 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,122.60 |
Browse Plan Formulary |
WellCare Liberty (HMO D-SNP)
|
$30.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,122.90 |
Browse Plan Formulary |
Aetna Medicare Assure (HMO D-SNP)
|
$30.80 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | None | $1,122.60 |
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 |
Allwell Medicare Nurture (HMO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,122.90 |
Browse Plan Formulary |
BlueMedicare Complete (HMO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | None | $1,073.70 |
Browse Plan Formulary |
Devoted Health Dual Greater Tampa Bay (HMO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,043.10 |
Browse Plan Formulary |
Devoted Health Prime Greater Tampa Bay (HMO)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,043.10 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom Medi-Medi Full (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Specialty Tier |
25% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Specialty Tier |
25% | n/a | S | $1,034.10 |
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 |
Longevity Health Plan (HMO I-SNP)
|
$30.80 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | P | $1,059.30 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $1,034.10 |
Browse Plan Formulary |
Optimum Emerald Full (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Specialty Tier |
25% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Specialty Tier |
25% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Simply Care (HMO I-SNP)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | S | $1,034.10 |
Browse Plan Formulary |
Simply Comfort (HMO I-SNP)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | S | $1,034.10 |
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 Complete (HMO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | S | $1,056.60 |
Browse Plan Formulary |
Simply Select (HMO)
|
$30.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | S | $1,034.10 |
Browse Plan Formulary |
SOLIS SPF 010 (HMO D-SNP)
|
$30.80 |
$0 |
No |
4 |
Non-Preferred Brand |
25% | n/a | P | $1,059.30 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
|
$30.80 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | Q:30 /30Days | $1,133.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,134.60 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,133.10 |
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 LP (HMO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,133.10 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
|
$30.80 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,133.40 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
|
$30.80 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,134.30 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$42.90 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $1,123.80 |
Browse Plan Formulary |
BlueMedicare Choice (Regional PPO)
|
$47.90 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | None | $1,054.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
WellCare Prime (PPO)
|
$75.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $1,123.20 |
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 |
BlueMedicare Select (PPO)
|
$146.80 |
$305 |
No |
5 |
Specialty Tier |
27% | n/a | None | $1,064.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |