REPATHA 140 MG/ML SURECLICK PEN INJCTR (2 mls ) (NDC: 72511076002)
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 |
BlueJourney Essential (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $463.54 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
BlueJourney Select (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $463.54 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $457.68 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $464.56 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $454.08 |
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 |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $457.12 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $457.48 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $464.10 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $454.70 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $457.12 |
Browse Plan Formulary |
Geisinger Gold Classic 360 Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $457.02 |
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 | P Q:3 /28Days | $456.80 |
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 | P Q:3 /28Days | $457.32 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $455.68 |
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 | P Q:3 /28Days | $457.08 |
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 |
Geisinger Gold Preferred 360 Rx (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $456.82 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred 360 Rx (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $457.26 |
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 | P Q:3 /28Days | $456.80 |
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 | P Q:3 /28Days | $457.32 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $455.68 |
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 | P Q:3 /28Days | $457.08 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5525-038 (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:3 /28Days | $500.84 |
Browse Plan Formulary |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $463.74 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $464.50 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Humana Gold Choice H8145-052 (PFFS)
|
$8.00 |
$360 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:3 /28Days | $500.66 |
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 Deductible with Rx (HMO)
|
$22.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:3 /28Days | $466.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Vibra Health Plan Enhanced Complete (PPO)
|
$26.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $464.00 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Humana Value Plus H5216-117 (PPO)
|
$26.90 |
$420 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:3 /28Days | $500.62 |
Browse Plan Formulary |
HumanaChoice H5525-006 (PPO)
|
$28.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:3 /28Days | $500.60 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.60 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:3 /28Days | $500.80 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.10 |
$445 |
No |
3 |
Tier 3 |
$0.00 | $0.00 | P Q:3 /28Days | $508.48 |
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 |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $457.48 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $464.10 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $454.70 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $120.00 | P Q:3 /28Days | $457.12 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$37.20 |
$445 |
No |
3 |
Tier 3 |
25% | 25% | P Q:3 /28Days | $508.48 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$37.40 |
$445 |
No |
2 |
Brand |
25% | 25% | P | $465.40 |
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 |
Geisinger Gold Secure Rx (HMO D-SNP)
|
$37.50 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P Q:3 /28Days | $456.72 |
Browse Plan Formulary |
UPMC for Life Complete Care (HMO D-SNP)
|
$37.50 |
$445 |
No |
3 |
Preferred Brand |
$18.00 | $45.00 | P Q:3 /28Days | $466.78 |
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 | P Q:3 /28Days | $456.80 |
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 | P Q:3 /28Days | $457.32 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $455.68 |
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 | P Q:3 /28Days | $457.08 |
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 | P Q:3 /28Days | $466.60 |
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 | P Q:3 /28Days | $457.16 |
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 | P Q:3 /28Days | $456.54 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueJourney Classic (PPO)
|
$49.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $463.54 |
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 |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $463.54 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
UPMC for Life PPO Rx Enhanced (PPO)
|
$60.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:3 /28Days | $459.34 |
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 | P Q:3 /28Days | $457.56 |
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 | P Q:3 /28Days | $466.60 |
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 | P Q:3 /28Days | $456.80 |
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 | P Q:3 /28Days | $457.32 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $456.78 |
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 | P Q:3 /28Days | $455.68 |
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 | P Q:3 /28Days | $457.08 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueJourney Premier (HMO)
|
$106.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:2 /28Days | $463.54 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
HumanaChoice H5216-120 (PPO)
|
$127.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:3 /28Days | $500.86 |
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 |
Geisinger Gold Classic Advantage Rx (HMO)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $456.80 |
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. |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $457.32 |
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. |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $456.78 |
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. |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $456.78 |
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. |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $455.68 |
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. |
3 |
Preferred Brand |
$47.00 | $70.50 | P Q:3 /28Days | $457.08 |
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 |
BlueJourney Prime (PPO)
|
$171.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:2 /28Days | $463.54 |
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 | P Q:3 /28Days | $457.56 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$289.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $115.00 | P Q:3 /28Days | $457.56 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced (HMO)
|
$302.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:3 /28Days | $466.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |