GLUCAGON 1 MG EMERGENCY KIT VIAL (1 ML ) (NDC: 00548585000)
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 Choice Plan 3 (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $236.04 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueJourney Essential (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:4 /30Days | $235.93 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$42.00 | $126.00 | None | $223.87 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$42.00 | $126.00 | None | $223.87 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $211.36 |
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 HMO Signature (HMO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $211.42 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $214.48 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $218.44 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $211.36 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $211.22 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $213.40 |
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 |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $218.44 |
Browse Plan Formulary |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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 | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Health Partners Medicare Complete (HMO-POS)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $94.00 | None | $252.00 |
Browse Plan Formulary |
UPMC for Life HMO Premier Rx (HMO)
|
$0.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $117.50 | None | $212.96 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:4 /30Days | $235.38 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:4 /30Days | $236.69 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
UPMC for Life HMO Deductible with Rx (HMO)
|
$22.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $117.50 | None | $211.72 |
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 |
AARP Medicare Advantage (HMO)
|
$23.50 |
$130 | No | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $236.03 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice Plan 1 (PPO)
|
$25.00 |
$95 | No | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $236.04 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$445 | No | 3 |
Tier 3 |
15% | 15% | None | $223.87 |
Browse Plan Formulary |
Vibra Health Plan Enhanced Complete (PPO)
|
$26.00 |
$0 | No | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:4 /30Days | $235.72 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Cigna True Choice Plus Medicare (PPO)
|
$29.00 |
$0 | No | 3 |
Preferred Brand |
$42.00 | $126.00 | None | $223.87 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.10 |
$445 | No | 3 |
Tier 3 |
$0.00 | $0.00 | None | $236.23 |
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 | None | $218.44 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $213.40 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $211.22 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $120.00 | None | $211.36 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$37.20 |
$445 | No | 3 |
Tier 3 |
25% | 25% | None | $236.23 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$37.40 |
$445 | No | 2 |
Brand |
25% | 25% | Q:4 /30Days | $258.92 |
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 |
Gateway Health Medicare Assured Diamond (HMO D-SNP)
|
$37.50 |
$445 | No | 4 |
Non-Preferred Drug |
49% | 49% | None | $252.00 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO D-SNP)
|
$37.50 |
$445 | No | 4 |
Non-Preferred Drug |
50% | 50% | None | $252.00 |
Browse Plan Formulary |
Geisinger Gold Secure Rx (HMO D-SNP)
|
$37.50 |
$445 | No | 1 |
Tier 1 |
15% | 15% | None | $252.00 |
Browse Plan Formulary |
Health Partners Medicare Prime (HMO-POS)
|
$37.50 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $94.00 | None | $252.00 |
Browse Plan Formulary |
Health Partners Medicare Special (HMO D-SNP)
|
$37.50 |
$445 | No | 1 |
Tier 1 |
$0.00 | $0.00 | None | $252.00 |
Browse Plan Formulary |
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
|
$37.50 |
$445 | No | 1 |
Tier 1 |
25% | 25% | None | $231.65 |
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 |
Provider Partners Pennsylvania Community Plan (HMO I-SNP)
|
$37.50 |
$445 | No | 1 |
Tier 1 |
25% | 25% | None | $231.65 |
Browse Plan Formulary |
UPMC for Life Complete Care (HMO D-SNP)
|
$37.50 |
$445 | No | 3 |
Preferred Brand |
$18.00 | $45.00 | None | $212.05 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UPMC for Life HMO Rx Choice (HMO)
|
$40.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $117.50 | None | $211.72 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$45.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$45.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueJourney Classic (PPO)
|
$49.00 |
$0 | No | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:4 /30Days | $235.93 |
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 | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:4 /30Days | $235.93 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
AARP Medicare Advantage Choice Plan 2 (PPO)
|
$58.00 |
$150* | No | 3* |
Preferred Brand |
$47.00 | $131.00 | None | $236.04 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UPMC for Life PPO Rx Enhanced (PPO)
|
$60.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $117.50 | None | $210.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Freedom Blue PPO ValueRx (PPO)
|
$70.00 |
$0 | No | 3 |
Preferred Brand |
$45.00 | $115.00 | None | $213.55 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$81.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $117.50 | None | $211.72 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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 Advantage Rx (PPO)
|
$85.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueJourney Premier (HMO)
|
$106.00 |
$0 | No | 4 |
Non-Preferred Drug |
$93.00 | $186.00 | Q:4 /30Days | $235.93 |
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 Classic Advantage Rx (HMO)
|
$150.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$150.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$150.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$150.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$150.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$150.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $70.50 | None | $252.00 |
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 |
BlueJourney Prime (PPO)
|
$171.00 |
$0 | No | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:4 /30Days | $235.93 |
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 | None | $213.55 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$289.00 |
$0 | No | 3 |
Preferred Brand |
$45.00 | $115.00 | None | $213.55 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced (HMO)
|
$302.00 |
$0 | No | 3 |
Preferred Brand |
$47.00 | $117.50 | None | $210.98 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |