RISPERIDONE TABLET 0.25MG 4 IN 1 BLPK (4 IN 1 BLPK) (NDC: 49884021255)
2021 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
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 Plan 1 (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $99.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Credit Value (PPO)
|
$0.00 |
$250 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $102.90 |
Browse Plan Formulary |
Aetna Medicare Advantra Gold (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $105.60 |
Browse Plan Formulary |
Aetna Medicare Advantra Silver (PPO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $104.70 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $104.70 |
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 |
Allwell Medicare (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $85.50 |
Browse Plan Formulary |
Allwell Medicare Boost (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $85.50 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $275.00 | Q:31 /31Days | $97.80 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $275.00 | Q:31 /31Days | $71.10 |
Browse Plan Formulary |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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 |
Geisinger Gold Classic Essential Rx (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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 |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Complete Rx (PPO)
|
$0.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5525-038 (PPO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $85.80 |
Browse Plan Formulary |
UPMC for Life HMO Premier Rx (HMO)
|
$0.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $95.10 |
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 |
UPMC for Life HMO Deductible with Rx (HMO)
|
$22.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $78.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Premier (HMO)
|
$25.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $104.70 |
Browse Plan Formulary |
Humana Value Plus H5525-039 (PPO)
|
$27.20 |
$400 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $86.10 |
Browse Plan Formulary |
Aetna Medicare Advantra Cares (HMO D-SNP)
|
$27.30 |
$220 | No | 4 |
Non-Preferred Drug |
35% | 35% | Q:90 /30Days | $102.60 |
Browse Plan Formulary |
HumanaChoice H5525-006 (PPO)
|
$28.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $85.80 |
Browse Plan Formulary |
Allwell Medicare Complement (HMO)
|
$29.50 |
$445 | No | 4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days | $87.30 |
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 SNP-DE H5216-227 (PPO D-SNP)
|
$29.50 |
$425 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $85.80 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.60 |
$0 | No | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:60 /30Days | $85.80 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.10 |
$445 | No | 4 |
Tier 4 |
$0.00 | $0.00 | None | $97.50 |
Browse Plan Formulary |
AARP Medicare Advantage Choice (PPO)
|
$35.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $99.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Plan 2 (HMO)
|
$35.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $99.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Complete Blue PPO Distinct (PPO)
|
$35.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $280.00 | Q:31 /31Days | $71.10 |
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 |
Complete Blue PPO Distinct (PPO)
|
$35.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $280.00 | Q:31 /31Days | $97.80 |
Browse Plan Formulary |
UPMC for Life PPO High Deductible with Rx (PPO)
|
$35.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $75.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$37.20 |
$445 | No | 4 |
Tier 4 |
25% | 25% | None | $97.50 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$37.40 |
$445 | No | 1 |
Generic |
$5.00 | $15.00 | Q:60 /30Days | $75.30 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO D-SNP)
|
$37.50 |
$445 | No | 4 |
Non-Preferred Drug |
42% | 42% | Q:90 /30Days | $85.50 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO D-SNP)
|
$37.50 |
$445 | No | 2 |
Generic |
$19.00 | $57.00 | Q:30 /30Days | $100.80 |
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 Ruby (HMO D-SNP)
|
$37.50 |
$445 | No | 2 |
Generic |
$20.00 | $60.00 | Q:30 /30Days | $100.80 |
Browse Plan Formulary |
Geisinger Gold Secure Rx (HMO D-SNP)
|
$37.50 |
$445 | No | 1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $40.50 |
Browse Plan Formulary |
UPMC for Life Complete Care (HMO D-SNP)
|
$37.50 |
$445 | No | 4 |
Non-Preferred Drug |
49% | 49% | S Q:60 /30Days | $75.90 |
Browse Plan Formulary |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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 |
Geisinger Gold Classic Complete Rx (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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. | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UPMC for Life HMO Rx Choice (HMO)
|
$40.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $78.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$45.00 |
$0 | No | 2 |
Generic |
$5.00 | $0.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Enhanced Rx (PPO)
|
$45.00 |
$0 | No | 2 |
Generic |
$5.00 | $0.00 | Q:60 /30Days | $40.50 |
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 |
Aetna Medicare Advantra Premier Plus (PPO)
|
$47.00 |
$0 | No | 4 |
Non-Preferred Drug |
$99.00 | $297.00 | Q:90 /30Days | $104.40 |
Browse Plan Formulary |
Security Blue HMO-POS ValueRx (HMO-POS)
|
$58.00 |
$0 | No | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:31 /31Days | $97.80 |
Browse Plan Formulary |
Security Blue HMO-POS ValueRx (HMO-POS)
|
$58.00 |
$0 | No | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:31 /31Days | $78.30 |
Browse Plan Formulary |
Aetna Medicare Silver (HMO)
|
$69.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $103.20 |
Browse Plan Formulary |
Freedom Blue PPO ValueRx (PPO)
|
$72.00 |
$0 | No | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:31 /31Days | $97.80 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$81.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $78.90 |
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)
|
$110.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$110.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$110.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$110.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$110.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Preferred Advantage Rx (PPO)
|
$110.00 |
$0 | No | 2 |
Generic |
$20.00 | $30.00 | Q:60 /30Days | $40.50 |
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 |
Freedom Blue PPO Select (PPO)
|
$131.00 |
$0 | No | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:31 /31Days | $97.80 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$136.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $75.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$159.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$159.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$159.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$159.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days | $40.50 |
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 |
Geisinger Gold Classic Advantage Rx (HMO)
|
$159.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$159.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$20.00 | $0.00 | Q:60 /30Days | $40.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Security Blue HMO-POS Standard (HMO-POS)
|
$165.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $250.00 | Q:31 /31Days | $78.30 |
Browse Plan Formulary |
Security Blue HMO-POS Standard (HMO-POS)
|
$165.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $250.00 | Q:31 /31Days | $70.50 |
Browse Plan Formulary |
Security Blue HMO-POS Standard (HMO-POS)
|
$165.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $250.00 | Q:31 /31Days | $98.40 |
Browse Plan Formulary |
Aetna Medicare Gold Plan (PPO)
|
$169.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:90 /30Days | $103.20 |
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 |
Security Blue HMO-POS Deluxe (HMO-POS)
|
$225.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $250.00 | Q:31 /31Days | $70.50 |
Browse Plan Formulary |
Security Blue HMO-POS Deluxe (HMO-POS)
|
$225.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $250.00 | Q:31 /31Days | $98.40 |
Browse Plan Formulary |
Security Blue HMO-POS Deluxe (HMO-POS)
|
$225.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $250.00 | Q:31 /31Days | $78.30 |
Browse Plan Formulary |
Freedom Blue PPO Classic (PPO)
|
$254.00 |
$0 | No | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:31 /31Days | $97.80 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced (HMO)
|
$302.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days | $79.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |