SAPHRIS 2.5 MG TABLET SL BLACK CHERRY (60 EA ) (NDC: 00456240260)
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 Plan 1 (HMO-POS)
|
$0.00 |
$195 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,558.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Plan 2 (HMO)
|
$0.00 |
$195 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,558.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | Q:60 /30Days | $2,533.20 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | Q:60 /30Days | $2,532.00 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$195 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,532.00 |
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 |
Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:240 /30Days | $2,336.40 |
Browse Plan Formulary |
Amerivantage Care To You (HMO I-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,336.40 |
Browse Plan Formulary |
Amerivantage Care To You Plus (HMO I-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,336.40 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,515.20 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,492.40 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,523.60 |
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 |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,503.20 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,612.40 |
Browse Plan Formulary |
Amerivantage Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,535.60 |
Browse Plan Formulary |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,535.60 |
Browse Plan Formulary |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,515.20 |
Browse Plan Formulary |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,492.40 |
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 |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,523.60 |
Browse Plan Formulary |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,503.20 |
Browse Plan Formulary |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,612.40 |
Browse Plan Formulary |
Amerivantage Diabetes Care (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,518.80 |
Browse Plan Formulary |
Amerivantage Diabetes Care Plus (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,518.80 |
Browse Plan Formulary |
Amerivantage Heart Care (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,518.80 |
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 |
Amerivantage Heart Care Plus (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,518.80 |
Browse Plan Formulary |
Amerivantage Lung Care (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,518.80 |
Browse Plan Formulary |
Amerivantage Lung Care Plus (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:240 /30Days | $2,518.80 |
Browse Plan Formulary |
Amerivantage Select (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:240 /30Days | $2,517.60 |
Browse Plan Formulary |
Amerivantage Select Plus (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:240 /30Days | $2,517.60 |
Browse Plan Formulary |
Blue Cross Medicare Advantage Basic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:60 /30Days | $2,336.40 |
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 |
Blue Cross Medicare Advantage Choice Plus (PPO)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:60 /30Days | $2,343.60 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$190 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,557.20 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$190 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,455.20 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$190 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,521.20 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$190 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,517.60 |
Browse Plan Formulary |
Erickson Advantage Liberty with Drugs (HMO-POS)
|
$0.00 |
$400 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $2,546.40 |
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 |
Humana Gold Plus H0028-042 (HMO)
|
$0.00 |
$195 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $2,534.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Connected (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:60 /30Days | $2,558.40 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)
|
$0.00 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | Q:60 /30Days | $2,559.60 |
Browse Plan Formulary |
WellCare Dividend Prime (HMO)
|
$0.00 |
$300 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
WellCare Guardian (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary select insulin pay $10 copay but not this drug |
WellCare Premier (PPO)
|
$0.00 |
$200 |
No |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days | $2,536.80 |
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 |
WellCare Rx Plus (PPO)
|
$0.00 |
$300 |
No |
4 |
Non-Preferred Drug |
45% | 45% | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
WellCare TexanPlus Choice (HMO-POS)
|
$0.00 |
$250 |
No |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
WellCare TexanPlus Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$80.00 | $160.00 | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
WellCare Value (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$90.00 | $180.00 | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
|
$4.90 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,559.60 |
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)
|
$7.00 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | Q:60 /30Days | $2,557.20 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
|
$7.00 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | Q:60 /30Days | $2,455.20 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
|
$7.00 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | Q:60 /30Days | $2,521.20 |
Browse Plan Formulary |
HumanaChoice H5216-043 (PPO)
|
$10.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $2,521.20 |
Browse Plan Formulary |
HumanaChoice H5216-043 (PPO)
|
$10.00 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | P Q:60 /30Days | $2,529.60 |
Browse Plan Formulary |
UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
|
$11.70 |
$295 |
No |
5 |
Specialty Tier |
27% | n/a | Q:60 /30Days | $2,559.60 |
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 Choice (PPO)
|
$15.00 |
$245 |
No |
5 |
Specialty Tier |
28% | n/a | Q:60 /30Days | $2,558.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Amerivantage Choice (PPO)
|
$15.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:240 /30Days | $2,523.60 |
Browse Plan Formulary |
WellCare Compass (HMO)
|
$16.20 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
WellCare Access (HMO D-SNP)
|
$17.70 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
|
$19.00 |
$300 |
No |
5 |
Specialty Tier |
27% | n/a | Q:60 /30Days | $2,532.00 |
Browse Plan Formulary |
WellCare Liberty (HMO D-SNP)
|
$20.30 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days | $2,536.80 |
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 |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$20.60 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,503.20 |
Browse Plan Formulary |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$20.60 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,612.40 |
Browse Plan Formulary |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$20.60 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,535.60 |
Browse Plan Formulary |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$20.60 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,515.20 |
Browse Plan Formulary |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$20.60 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,492.40 |
Browse Plan Formulary |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$20.60 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,523.60 |
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 |
Amerivantage Dual Secure (HMO D-SNP)
|
$21.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,523.60 |
Browse Plan Formulary |
Aetna Medicare Dual Complete Plan (HMO D-SNP)
|
$22.50 |
$220 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,533.20 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,503.20 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,612.40 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,535.60 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,515.20 |
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 |
Amerivantage Dual Coordination (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,492.40 |
Browse Plan Formulary |
Amerivantage Dual Coordination (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,523.60 |
Browse Plan Formulary |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,503.20 |
Browse Plan Formulary |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,612.40 |
Browse Plan Formulary |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,535.60 |
Browse Plan Formulary |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,515.20 |
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 |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,492.40 |
Browse Plan Formulary |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:240 /30Days | $2,523.60 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)
|
$22.50 |
$425 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $2,530.80 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP)
|
$22.50 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $2,534.40 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$22.50 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | Q:60 /30Days | $2,560.80 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$22.50 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | Q:60 /30Days | $2,558.40 |
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 |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$22.50 |
$445 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | Q:60 /30Days | $2,528.40 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
|
$22.50 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | Q:60 /30Days | $2,558.40 |
Browse Plan Formulary |
WellCare Imperial (PPO D-SNP)
|
$22.50 |
$445 |
No |
4 |
Non-Preferred Drug |
46% | 46% | Q:60 /30Days | $2,536.80 |
Browse Plan Formulary |
Erickson Advantage Guardian (HMO-POS I-SNP)
|
$28.80 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $2,546.40 |
Browse Plan Formulary select insulin pay $28 copay but not this drug |
HumanaChoice R4182-004 (Regional PPO)
|
$37.10 |
$175 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:60 /30Days | $2,529.60 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Choice (Regional PPO)
|
$38.80 |
$395 |
No |
5 |
Specialty Tier |
25% | n/a | Q:60 /30Days | $2,559.60 |
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 |
HumanaChoice R4182-003 (Regional PPO)
|
$41.00 |
$175 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:60 /30Days | $2,529.60 |
Browse Plan Formulary |
Erickson Advantage Freedom (HMO-POS)
|
$70.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | Q:60 /30Days | $2,546.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Blue Cross Medicare Advantage Choice Premier (PPO)
|
$90.00 |
$295 |
No |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:60 /30Days | $2,343.60 |
Browse Plan Formulary |
HumanaChoice H5216-042 (PPO)
|
$93.00 |
$175 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:60 /30Days | $2,529.60 |
Browse Plan Formulary |
Humana Gold Choice H8145-084 (PFFS)
|
$96.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | P Q:60 /30Days | $2,534.40 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS C-SNP)
|
$199.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $2,546.40 |
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 |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$199.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | Q:60 /30Days | $2,546.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |