HUMIRA 40 MG/0.4 ML PEN IJ KIT (2 units ) (NDC: 00074055402)
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 |
5 |
Specialty Tier |
33% | n/a | P | $6,369.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Credit Value (PPO)
|
$0.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | P Q:6 /28Days | $6,327.34 |
Browse Plan Formulary |
Aetna Medicare Advantra Silver (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,302.40 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,305.00 |
Browse Plan Formulary |
BlueJourney Essential (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $5,663.88 |
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 |
5 |
Specialty Tier |
33% | n/a | P | $5,663.88 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $6,676.48 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $6,676.48 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,871.54 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,886.70 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,920.06 |
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 |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,756.02 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,920.06 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,758.24 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,869.46 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,886.70 |
Browse Plan Formulary |
Geisinger Gold Classic 360 Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.72 |
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 |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.12 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,729.18 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,721.94 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.66 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,723.10 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,712.14 |
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 360 Rx (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,686.48 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred 360 Rx (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,726.76 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.66 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,723.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,712.14 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.12 |
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 |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,729.18 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,721.94 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5525-038 (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,283.14 |
Browse Plan Formulary |
UPMC for Life HMO Premier Rx (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,773.12 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $5,670.84 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $5,608.18 |
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 Choice H8145-052 (PFFS)
|
$8.00 |
$360 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:6 /28Days | $6,259.26 |
Browse Plan Formulary |
Aetna Medicare Advantra Silver Plus (PPO)
|
$19.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,302.40 |
Browse Plan Formulary |
UPMC for Life HMO Deductible with Rx (HMO)
|
$22.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,837.54 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage (HMO)
|
$23.50 |
$130 |
No |
5 |
Specialty Tier |
30% | n/a | P | $6,370.72 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice Plan 1 (PPO)
|
$25.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P | $6,369.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Premier (HMO)
|
$25.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,302.40 |
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 |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | P Q:4 /28Days | $6,676.48 |
Browse Plan Formulary |
Vibra Health Plan Enhanced Complete (PPO)
|
$26.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $5,619.82 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Humana Value Plus H5216-117 (PPO)
|
$26.90 |
$420 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $6,266.58 |
Browse Plan Formulary |
Aetna Medicare Advantra Cares (HMO D-SNP)
|
$27.30 |
$220 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:6 /28Days | $6,328.40 |
Browse Plan Formulary |
HumanaChoice H5525-006 (PPO)
|
$28.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,266.58 |
Browse Plan Formulary |
Cigna True Choice Plus Medicare (PPO)
|
$29.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $6,676.48 |
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 |
HumanaChoice R0923-002 (Regional PPO)
|
$29.60 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,277.92 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.10 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P | $6,371.68 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO D-SNP)
|
$34.20 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $6,303.00 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,920.06 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,758.24 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,869.46 |
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 |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,886.70 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$37.20 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | P | $6,371.54 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$37.40 |
$445 |
No |
2 |
Brand |
25% | 25% | P | $5,825.22 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO D-SNP)
|
$37.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $5,658.60 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO D-SNP)
|
$37.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:6 /28Days | $5,658.60 |
Browse Plan Formulary |
Geisinger Gold Secure Rx (HMO D-SNP)
|
$37.50 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P Q:4 /28Days | $5,723.50 |
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 |
UPMC for Life Complete Care (HMO D-SNP)
|
$37.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:2 /28Days | $5,838.96 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.66 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,723.10 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,712.14 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.12 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,729.18 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,721.94 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UPMC for Life HMO Rx Choice (HMO)
|
$40.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,837.54 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$45.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,720.22 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$45.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,728.84 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Premier Plus (PPO)
|
$47.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,302.40 |
Browse Plan Formulary |
BlueJourney Classic (PPO)
|
$49.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $5,663.88 |
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 |
5 |
Specialty Tier |
33% | n/a | P | $5,663.88 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
AARP Medicare Advantage Choice Plan 2 (PPO)
|
$58.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P | $6,369.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UPMC for Life PPO Rx Enhanced (PPO)
|
$60.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,768.58 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Silver (HMO)
|
$69.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,326.40 |
Browse Plan Formulary |
Freedom Blue PPO ValueRx (PPO)
|
$70.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,817.42 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$81.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,837.54 |
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 |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.66 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,723.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,712.14 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.12 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,729.18 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$85.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,721.94 |
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 Premier (HMO)
|
$106.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $5,663.88 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
HumanaChoice H5216-120 (PPO)
|
$127.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,287.30 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.66 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,723.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,712.14 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,727.12 |
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)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,729.18 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,721.94 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Gold Plan (PPO)
|
$169.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:6 /28Days | $6,326.40 |
Browse Plan Formulary |
BlueJourney Prime (PPO)
|
$171.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $5,663.88 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Freedom Blue PPO Standard (PPO)
|
$175.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,817.42 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$289.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,817.42 |
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 |
UPMC for Life HMO Rx Enhanced (HMO)
|
$302.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $5,837.38 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |