EPINEPHRINE 0.15 MG AUTO-INJECT [Twinject] (2 units ) (NDC: 49502010102)
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 |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:4 /30Days | $413.62 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice (PPO)
|
$0.00 |
$150 |
No |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:4 /30Days | $415.02 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice Plan 2 (Regional PPO)
|
$0.00 |
$395 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $413.78 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Focus (HMO-POS)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:4 /30Days | $423.26 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$20.00 | $40.00 | None | $264.58 |
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 |
2 |
Preferred Brand |
$20.00 | $40.00 | None | $264.58 |
Browse Plan Formulary select insulin pay $10 copay but not this drug |
Aetna Medicare Choice (HMO-POS)
|
$0.00 |
$195 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:2 /30Days | $103.80 |
Browse Plan Formulary |
Aetna Medicare Premier (PPO)
|
$0.00 |
$300 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:2 /30Days | $95.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:2 /30Days | $97.80 |
Browse Plan Formulary |
Aetna Medicare Select (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:2 /30Days | $96.46 |
Browse Plan Formulary select insulin pay $20 copay but not this drug |
Align Connect (HMO C-SNP)
|
$0.00 |
$445 |
No |
2 |
Generic |
$15.00 | n/a | Q:2 /15Days | $301.08 |
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 |
2 |
Generic |
$15.00 | n/a | Q:2 /15Days | $301.08 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BayCarePlus Complete (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$4.00 | $0.00 | Q:4 /30Days | $262.50 |
Browse Plan Formulary |
BayCarePlus Rewards (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$10.00 | $0.00 | Q:4 /30Days | $262.50 |
Browse Plan Formulary |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $262.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | None | $262.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Saver (HMO)
|
$0.00 |
$50 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $262.50 |
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 |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $262.50 |
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. |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:4 /30Days | $269.22 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareFree (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:4 /30Days | $269.02 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareFree (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $95.00 | Q:4 /30Days | $269.58 |
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. |
3 |
Preferred Brand |
$10.00 | $20.00 | Q:4 /30Days | $269.02 |
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. |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:4 /30Days | $269.02 |
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. |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:4 /30Days | $269.58 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | Q:2 /30Days | $291.60 |
Browse Plan Formulary |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$4.00 | $0.00 | Q:2 /30Days | $291.60 |
Browse Plan Formulary |
Devoted Health Core Greater Tampa Bay (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$8.00 | $20.00 | None | $281.24 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Devoted Health Essentials Greater Tampa Bay (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $281.24 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$35.00 | $70.00 | Q:2 /28Days | $265.72 |
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 |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom VIP Savings (HMO C-SNP)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$30.00 | $60.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary select insulin pay $0-$10 copay but not this drug |
Freedom VIP Savings COPD (HMO C-SNP)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:4 /30Days | $268.98 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Humana Gold Plus H1036-025 (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$5.00 | $5.00 | Q:4 /30Days | $269.00 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Humana Gold Plus H1036-265 (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:4 /30Days | $268.90 |
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 |
Humana Gold Plus H1036-265 (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:4 /30Days | $269.00 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
HumanaChoice Florida H5216-072 (PPO)
|
$0.00 |
$150 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $269.22 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$395 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $269.12 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO C-SNP)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary select insulin pay $0-$10 copay but not this drug |
Optimum Diamond Rewards COPD (HMO C-SNP)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$35.00 | $70.00 | Q:2 /28Days | $265.72 |
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 |
2 |
Preferred Brand |
$10.00 | $20.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Premier by Ultimate (HMO)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$35.00 | $70.00 | None | $264.58 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Premier Plus by Ultimate (HMO)
|
$0.00 |
$0 |
No |
2 |
Preferred Brand |
$25.00 | $50.00 | None | $264.58 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
No |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
SOLIS SPF 009 (HMO)
|
$0.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | Q:2 /15Days | $299.74 |
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 |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $389.92 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
|
$0.00 |
$150* |
No |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $415.54 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
|
$0.00 |
$150* |
No |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $408.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
|
$0.00 |
$150* |
No |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $432.74 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
WellCare Champion (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | None | $281.24 |
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. |
2 |
Generic |
$5.00 | $0.00 | None | $281.24 |
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. |
2 |
Generic |
$0.00 | $0.00 | None | $281.24 |
Browse Plan Formulary |
WellCare Guardian (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $281.24 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
WellCare Premier (PPO)
|
$0.00 |
$100* |
No |
2* |
Generic |
$0.00 | $0.00 | None | $281.24 |
Browse Plan Formulary |
CareNeeds PLUS (HMO D-SNP)
|
$14.00 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $269.22 |
Browse Plan Formulary |
Cigna Primary Medicare (HMO)
|
$17.90 |
$445* |
No |
2* |
Generic |
$15.00 | $30.00 | Q:2 /30Days | $291.60 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
|
$18.00 |
$445* |
No |
2* |
Generic |
$15.00 | $30.00 | Q:2 /30Days | $291.60 |
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 |
Humana Fully Integrated H1036-283 (HMO D-SNP)
|
$19.50 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $269.18 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP)
|
$24.50 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $268.98 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO D-SNP)
|
$25.00 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $262.70 |
Browse Plan Formulary |
Aetna Medicare Assure Plus (HMO D-SNP)
|
$28.00 |
$250 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:2 /30Days | $92.36 |
Browse Plan Formulary |
BayCarePlus Signature (HMO)
|
$28.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | Q:4 /30Days | $262.50 |
Browse Plan Formulary |
WellCare Access (HMO D-SNP)
|
$28.10 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $281.24 |
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 |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $281.24 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
|
$29.40 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $281.24 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
|
$29.40 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $281.24 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
|
$29.40 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $281.24 |
Browse Plan Formulary |
WellCare Liberty (HMO D-SNP)
|
$30.50 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $281.24 |
Browse Plan Formulary |
Aetna Medicare Assure (HMO D-SNP)
|
$30.80 |
$250 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:2 /30Days | $94.92 |
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 |
Allwell Medicare Nurture (HMO D-SNP)
|
$30.80 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $264.26 |
Browse Plan Formulary |
BlueMedicare Complete (HMO D-SNP)
|
$30.80 |
$445* |
No |
2* |
Generic |
$0.00 | $0.00 | None | $262.50 |
Browse Plan Formulary |
Devoted Health Dual Greater Tampa Bay (HMO D-SNP)
|
$30.80 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | None | $281.24 |
Browse Plan Formulary |
Devoted Health Prime Greater Tampa Bay (HMO)
|
$30.80 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | None | $281.24 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom Medi-Medi Full (HMO D-SNP)
|
$30.80 |
$445 |
No |
2 |
Preferred Brand |
$45.00 | $135.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO D-SNP)
|
$30.80 |
$445 |
No |
2 |
Preferred Brand |
$45.00 | $135.00 | Q:2 /28Days | $265.72 |
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 | Q:2 /15Days | $301.84 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.80 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $281.24 |
Browse Plan Formulary |
Optimum Emerald Full (HMO D-SNP)
|
$30.80 |
$445 |
No |
2 |
Preferred Brand |
$45.00 | $135.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO D-SNP)
|
$30.80 |
$445 |
No |
2 |
Preferred Brand |
$45.00 | $135.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Simply Care (HMO I-SNP)
|
$30.80 |
$445 |
No |
1 |
Preferred Generic |
$4.00 | n/a | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
Simply Comfort (HMO I-SNP)
|
$30.80 |
$445* |
No |
1* |
Preferred Generic |
$0.00 | n/a | Q:2 /28Days | $265.72 |
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 |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:2 /28Days | $269.36 |
Browse Plan Formulary |
Simply Select (HMO)
|
$30.80 |
$445* |
No |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:2 /28Days | $265.72 |
Browse Plan Formulary |
SOLIS SPF 010 (HMO D-SNP)
|
$30.80 |
$0 |
No |
2 |
Generic |
0% | 0% | Q:2 /15Days | $299.74 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
|
$30.80 |
$200* |
No |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:4 /30Days | $417.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$30.80 |
$445 |
No |
3 |
Tier 3 |
15% | 15% | Q:4 /30Days | $416.36 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$30.80 |
$445 |
No |
3 |
Tier 3 |
15% | 15% | Q:4 /30Days | $413.22 |
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 |
3 |
Tier 3 |
15% | 15% | Q:4 /30Days | $412.16 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
|
$30.80 |
$445 |
No |
3 |
Tier 3 |
15% | 15% | Q:4 /30Days | $413.78 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
|
$30.80 |
$445 |
No |
3 |
Tier 3 |
25% | 25% | Q:4 /30Days | $413.82 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$42.90 |
$100 |
No |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:4 /30Days | $269.12 |
Browse Plan Formulary |
BlueMedicare Choice (Regional PPO)
|
$47.90 |
$250 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $263.54 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
WellCare Prime (PPO)
|
$75.00 |
$0 |
No |
2 |
Generic |
$0.00 | $0.00 | None | $281.24 |
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 |
2 |
Generic |
$10.00 | $30.00 | None | $264.18 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |