RISPERDAL CONSTA 50MG SYR (50 MG VIAL DSPK) (NDC: 50458030811)
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 | None | $1,126.10 |
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 | Q:2 /28Days | $1,124.15 |
Browse Plan Formulary |
Aetna Medicare Advantra Silver (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,119.81 |
Browse Plan Formulary |
Aetna Medicare PinnacleHealth Prime (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,125.58 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,123.38 |
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 (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,127.57 |
Browse Plan Formulary |
Allwell Medicare (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,125.84 |
Browse Plan Formulary |
Allwell Medicare Boost (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,126.08 |
Browse Plan Formulary |
BlueJourney Essential (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,072.11 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
BlueJourney Select (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,072.11 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,171.06 |
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 |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,171.06 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,079.89 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,079.07 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,047.98 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,051.30 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,079.89 |
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 |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,078.41 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,047.98 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,048.65 |
Browse Plan Formulary |
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:2 /28Days | $1,018.89 |
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:2 /28Days | $1,021.02 |
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:2 /28Days | $1,016.63 |
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:2 /28Days | $1,016.66 |
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:2 /28Days | $1,021.80 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $1,019.35 |
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:2 /28Days | $1,018.89 |
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:2 /28Days | $1,021.02 |
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:2 /28Days | $1,016.63 |
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:2 /28Days | $1,016.66 |
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:2 /28Days | $1,021.80 |
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:2 /28Days | $1,019.35 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Health Partners Medicare Complete (HMO-POS)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,036.70 |
Browse Plan Formulary |
Humana Gold Plus H6622-035 (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,121.46 |
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 | Q:2 /28Days | $1,119.73 |
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 Premier Rx (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,064.99 |
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 | Q:2 /28Days | $1,063.29 |
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 | Q:2 /28Days | $1,072.06 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Humana Gold Choice H8145-052 (PFFS)
|
$8.00 |
$360 |
No |
5 |
Specialty Tier |
26% | n/a | Q:2 /28Days | $1,120.49 |
Browse Plan Formulary |
Aetna Medicare Advantra Silver Plus (PPO)
|
$19.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,118.35 |
Browse Plan Formulary |
UPMC for Life HMO Deductible with Rx (HMO)
|
$22.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,066.01 |
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 |
5 |
Specialty Tier |
30% | n/a | None | $1,124.20 |
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 | None | $1,126.10 |
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 | Q:2 /28Days | $1,119.81 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | None | $1,171.06 |
Browse Plan Formulary |
Vibra Health Plan Enhanced Complete (PPO)
|
$26.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,068.86 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Humana Gold Plus SNP-DE H6622-038 (HMO D-SNP)
|
$26.10 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,119.94 |
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 |
Aetna Medicare Advantra Cares (HMO D-SNP)
|
$27.30 |
$220 |
No |
5 |
Specialty Tier |
29% | n/a | Q:2 /28Days | $1,123.76 |
Browse Plan Formulary |
HumanaChoice H5525-006 (PPO)
|
$28.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,120.65 |
Browse Plan Formulary |
Cigna True Choice Plus Medicare (PPO)
|
$29.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,171.06 |
Browse Plan Formulary |
Allwell Medicare Complement (HMO)
|
$29.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,126.77 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.60 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,119.74 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.10 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | None | $1,117.14 |
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 Dual Medicare (HMO D-SNP)
|
$34.20 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | Q:2 /28Days | $1,126.04 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,079.89 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,078.41 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,047.98 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,048.65 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$37.20 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | None | $1,121.40 |
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 |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$37.40 |
$445 |
No |
2 |
Brand |
25% | 25% | P Q:2 /28Days | $1,049.26 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO D-SNP)
|
$37.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:2 /28Days | $1,011.67 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO D-SNP)
|
$37.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:2 /28Days | $1,011.67 |
Browse Plan Formulary |
Geisinger Gold Secure Rx (HMO D-SNP)
|
$37.50 |
$445 |
No |
1 |
Tier 1 |
15% | 15% | P Q:2 /28Days | $1,017.73 |
Browse Plan Formulary |
Health Partners Medicare Prime (HMO-POS)
|
$37.50 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | None | $1,036.70 |
Browse Plan Formulary |
Health Partners Medicare Special (HMO D-SNP)
|
$37.50 |
$445 |
No |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,036.70 |
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 | Q:2 /28Days | $1,068.33 |
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:2 /28Days | $1,018.89 |
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:2 /28Days | $1,021.02 |
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:2 /28Days | $1,016.63 |
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:2 /28Days | $1,016.66 |
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:2 /28Days | $1,021.80 |
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:2 /28Days | $1,019.35 |
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 | Q:2 /28Days | $1,066.01 |
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:2 /28Days | $1,017.62 |
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:2 /28Days | $1,021.77 |
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 | Q:2 /28Days | $1,123.71 |
Browse Plan Formulary |
BlueJourney Classic (PPO)
|
$49.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,072.11 |
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 | Q:2 /28Days | $1,072.11 |
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 | None | $1,126.10 |
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 | Q:2 /28Days | $1,055.83 |
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 | Q:2 /28Days | $1,124.18 |
Browse Plan Formulary |
Freedom Blue PPO ValueRx (PPO)
|
$70.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,063.71 |
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 | Q:2 /28Days | $1,066.01 |
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:2 /28Days | $1,016.63 |
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:2 /28Days | $1,016.66 |
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:2 /28Days | $1,021.80 |
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:2 /28Days | $1,019.35 |
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:2 /28Days | $1,018.89 |
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:2 /28Days | $1,021.02 |
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 |
BlueJourney Premier (HMO)
|
$106.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,072.11 |
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 | Q:2 /28Days | $1,119.77 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$150.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $1,018.89 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $1,021.02 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $1,016.63 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $1,016.66 |
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)
|
$150.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $1,021.80 |
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. |
5 |
Specialty Tier |
33% | n/a | P Q:2 /28Days | $1,019.35 |
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 | Q:2 /28Days | $1,124.18 |
Browse Plan Formulary |
BlueJourney Prime (PPO)
|
$171.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,072.11 |
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 | Q:2 /28Days | $1,063.71 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$289.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:2 /28Days | $1,063.71 |
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 | Q:2 /28Days | $1,067.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |