ARISTADA ER 1064 MG/3.9 ML SYRINGE (3.9 ML ) (NDC: 65757040403)
2021 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Aetna Medicare Premier (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,693.88 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,693.88 |
Browse Plan Formulary |
Align Connect (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Align Connect (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P | $3,533.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
5 |
Specialty Tier |
32% | n/a | S | $3,407.68 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
5 |
Specialty Tier |
32% | n/a | S | $3,448.36 |
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 |
BCN Advantage Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
5 |
Specialty Tier |
32% | n/a | S | $3,370.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
5 |
Specialty Tier |
32% | n/a | S | $3,557.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
5 |
Specialty Tier |
32% | n/a | S | $3,460.88 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HAP Primary Choice (HMO)
![Email Prescription and/or Health Benefit details for HAP Primary Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,566.64 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
HAP Senior Plus (HMO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,543.24 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
HAP Senior Plus Option 1 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 1 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,549.52 |
Browse Plan Formulary select insulin pay $15-$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 H8908-004 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8908-004 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,673.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,386.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,448.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,370.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,557.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,459.12 |
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 |
PriorityMedicare Edge (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Edge (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,490.16 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Edge (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,371.92 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Edge (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,482.00 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,490.16 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,303.56 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,334.80 |
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 |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,371.92 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,481.68 |
Browse Plan Formulary |
PriorityMedicare Vital (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Vital (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | None | $3,490.16 |
Browse Plan Formulary |
PriorityMedicare Vital (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Vital (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | None | $3,371.92 |
Browse Plan Formulary |
PriorityMedicare Vital (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Vital (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No |
5 |
Specialty Tier |
26% | n/a | None | $3,482.00 |
Browse Plan Formulary |
WellCare Dividend (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:4 /56Days | $3,696.64 |
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 Essential (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Essential (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,694.40 |
Browse Plan Formulary |
WellCare Explore (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Explore (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,694.40 |
Browse Plan Formulary |
WellCare Elite Smile (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Elite Smile (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.10 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,694.40 |
Browse Plan Formulary |
BCN Advantage Community Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage Community Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,557.40 |
Browse Plan Formulary |
BCN Advantage Community Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage Community Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,568.00 |
Browse Plan Formulary |
HumanaChoice H8087-001 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H8087-001 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | Q:4 /56Days | $3,668.56 |
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 |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$125 |
No |
5 |
Specialty Tier |
30% | n/a | None | $3,490.16 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$125 |
No |
5 |
Specialty Tier |
30% | n/a | None | $3,303.56 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$125 |
No |
5 |
Specialty Tier |
30% | n/a | None | $3,334.80 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$125 |
No |
5 |
Specialty Tier |
30% | n/a | None | $3,371.92 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$125 |
No |
5 |
Specialty Tier |
30% | n/a | None | $3,482.00 |
Browse Plan Formulary |
Humana Value Plus H8087-002 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H8087-002 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$260 |
No |
5 |
Specialty Tier |
28% | n/a | Q:4 /56Days | $3,652.76 |
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 H8908-005 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$425 |
No |
5 |
Specialty Tier |
25% | n/a | Q:4 /56Days | $3,673.36 |
Browse Plan Formulary |
Align Thrive (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Align Thrive (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | P | $3,533.40 |
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) |
$30.10 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | P | $3,541.20 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:4 /56Days | $3,402.20 |
Browse Plan Formulary |
PriorityMedicare D-SNP (HMO D-SNP)
![Email Prescription and/or Health Benefit details for PriorityMedicare D-SNP (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | None | $3,474.72 |
Browse Plan Formulary |
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) |
$30.10 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | None | $3,553.48 |
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 Extra Plus (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Extra Plus (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:4 /56Days | $3,694.40 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R3887-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.40 |
$380 |
No |
5 |
Specialty Tier |
26% | n/a | Q:4 /56Days | $3,669.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,693.88 |
Browse Plan Formulary |
Humana Gold Plus H8908-001 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8908-001 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,673.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,490.16 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,303.56 |
Browse Plan Formulary select insulin pay $15-$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 |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,334.80 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,371.92 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | None | $3,481.68 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
WellCare Elite (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Elite (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:4 /56Days | $3,694.40 |
Browse Plan Formulary |
BCN Advantage HMO ConnectedCare (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO ConnectedCare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,550.48 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HAP Senior Plus Option 2 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 2 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,549.52 |
Browse Plan Formulary select insulin pay $15-$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 |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,557.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,459.12 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,386.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,448.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | S | $3,370.36 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,549.52 |
Browse Plan Formulary select insulin pay $15-$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 |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,371.92 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,482.00 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,490.16 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,303.56 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,334.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$104.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,557.40 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$104.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,460.88 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$104.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,407.68 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$104.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,448.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$104.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,370.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,481.68 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,490.16 |
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 |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,303.56 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,334.80 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,371.92 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$122.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,448.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$122.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,370.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$122.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,557.40 |
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 |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$122.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,459.12 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$122.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,386.08 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 3 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$160.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,549.52 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
HAP Senior Plus Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$190.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,549.52 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
HAP Senior Plus Option 4 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 4 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$200.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $3,549.52 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$206.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,371.92 |
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 |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$206.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,482.00 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$206.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,490.16 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$206.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,303.56 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$206.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $3,334.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$227.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,557.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$227.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,460.88 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$227.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,407.68 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$227.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,448.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$227.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,370.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$260.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,557.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$260.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,459.12 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$260.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,386.08 |
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 |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$260.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,448.36 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$260.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | S | $3,370.36 |
Browse Plan Formulary |