BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex] (30 tablets ) (NDC: 00054017713)
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 |
Aetna Medicare Advantra Credit Value (PPO)
|
$0.00 |
$250* |
No |
2* |
Generic |
$7.00 | $14.00 | P Q:90 /30Days | $34.20 |
Browse Plan Formulary |
Aetna Medicare Advantra Gold (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | P Q:90 /30Days | $39.00 |
Browse Plan Formulary |
Aetna Medicare Advantra Silver (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | P Q:90 /30Days | $36.60 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $10.00 | P Q:90 /30Days | $31.80 |
Browse Plan Formulary |
BlueJourney Essential (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$5.00 | $15.00 | Q:90 /30Days | $123.00 |
Browse Plan Formulary select insulin pay $5 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 |
BlueJourney Select (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$12.00 | $36.00 | Q:90 /30Days | $123.00 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $133.80 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $133.80 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $133.80 |
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 |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $133.80 |
Browse Plan Formulary |
Geisinger Gold Classic 360 Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
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 |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
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 |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$5.00 | $0.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$5.00 | $0.00 | Q:90 /30Days | $35.40 |
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 |
Humana Gold Plus H6622-036 (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$8.00 | $0.00 | Q:90 /30Days | $94.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5525-038 (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$17.00 | $0.00 | Q:90 /30Days | $93.60 |
Browse Plan Formulary |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $126.60 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $118.20 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Aetna Medicare Advantra Premier (HMO)
|
$25.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | P Q:90 /30Days | $36.60 |
Browse Plan Formulary |
Vibra Health Plan Enhanced Complete (PPO)
|
$26.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $124.20 |
Browse Plan Formulary select insulin pay $5 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 SNP-DE H6622-038 (HMO D-SNP)
|
$26.10 |
$445 |
No |
2 |
Generic |
$19.00 | $0.00 | Q:90 /30Days | $91.80 |
Browse Plan Formulary |
Humana Value Plus H5216-117 (PPO)
|
$26.90 |
$420 |
No |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $94.80 |
Browse Plan Formulary |
Aetna Medicare Advantra Cares (HMO D-SNP)
|
$27.30 |
$220* |
No |
2* |
Generic |
$0.00 | $0.00 | P Q:90 /30Days | $36.60 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.60 |
$0 |
No |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $94.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.10 |
$445 |
No |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $130.20 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO D-SNP)
|
$34.20 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | P Q:90 /30Days | $60.00 |
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 |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $133.80 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | Q:62 /31Days | $133.80 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$37.20 |
$445 |
No |
2 |
Tier 2 |
25% | 25% | Q:90 /30Days | $130.20 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$37.40 |
$445 |
No |
1 |
Generic |
$5.00 | $15.00 | None | $65.40 |
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 |
Gateway Health Medicare Assured Diamond (HMO D-SNP)
|
$37.50 |
$445 |
No |
2 |
Generic |
$19.00 | $57.00 | Q:60 /30Days | $54.60 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO D-SNP)
|
$37.50 |
$445 |
No |
2 |
Generic |
$20.00 | $60.00 | Q:60 /30Days | $54.60 |
Browse Plan Formulary |
Geisinger Gold Secure Rx (HMO D-SNP)
|
$37.50 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $35.40 |
Browse Plan Formulary |
UPMC for Life Complete Care (HMO D-SNP)
|
$37.50 |
$445 |
No |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days | $100.80 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
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 |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Premier Plus (PPO)
|
$47.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | P Q:90 /30Days | $36.00 |
Browse Plan Formulary |
BlueJourney Classic (PPO)
|
$49.00 |
$0 |
No |
2 |
Generic |
$5.00 | $15.00 | Q:90 /30Days | $123.00 |
Browse Plan Formulary select insulin pay $5 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 |
BlueJourney Value (HMO)
|
$51.00 |
$0 |
No |
2 |
Generic |
$5.00 | $15.00 | Q:90 /30Days | $123.00 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
HumanaChoice H5525-007 (PPO)
|
$54.00 |
$0 |
No |
2 |
Generic |
$15.00 | $0.00 | Q:90 /30Days | $94.80 |
Browse Plan Formulary |
Aetna Medicare Silver (HMO)
|
$69.00 |
$0 |
No |
2 |
Generic |
$5.00 | $10.00 | P Q:90 /30Days | $36.00 |
Browse Plan Formulary |
Freedom Blue PPO ValueRx (PPO)
|
$70.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $115.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
|
$100.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | P Q:90 /30Days | $25.20 |
Browse Plan Formulary |
BlueJourney Premier (HMO)
|
$106.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $123.00 |
Browse Plan Formulary select insulin pay $5 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 |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$115.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$115.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$115.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$115.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$115.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$115.00 |
$0 |
No |
2 |
Generic |
$20.00 | $30.00 | Q:90 /30Days | $35.40 |
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 |
HumanaChoice H5216-120 (PPO)
|
$127.00 |
$0 |
No |
2 |
Generic |
$15.00 | $0.00 | Q:90 /30Days | $93.60 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$166.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$166.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$166.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$166.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$166.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $35.40 |
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 |
Geisinger Gold Classic Advantage Rx (HMO)
|
$166.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $35.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Gold Plan (PPO)
|
$169.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $10.00 | P Q:90 /30Days | $33.60 |
Browse Plan Formulary |
BlueJourney Prime (PPO)
|
$171.00 |
$0 |
No |
2 |
Generic |
$5.00 | $15.00 | Q:90 /30Days | $123.00 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Freedom Blue PPO Standard (PPO)
|
$175.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $115.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$289.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $115.00 | Q:62 /31Days | $134.40 |
Browse Plan Formulary |