UDENYCA 6 MG/0.6 ML SYRINGE (ml ) (NDC: 70114010101)
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 | $7,386.28 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueJourney Essential (HMO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,624.90 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,959.05 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,959.05 |
Browse Plan Formulary |
Community Blue Medicare HMO Signature (HMO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,959.05 |
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 | None | $6,420.74 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,958.52 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,958.52 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,958.52 |
Browse Plan Formulary |
Community Blue Medicare PPO Signature (PPO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,420.74 |
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 | $6,680.00 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,680.00 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,680.00 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,680.00 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | P | $6,767.68 |
Browse Plan Formulary |
Humana Gold Plus H6622-036 (HMO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:1 /28Days | $7,140.89 |
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:1 /28Days | $7,306.25 |
Browse Plan Formulary |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,972.58 |
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 |
Vibra Essential Advocate (PPO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,624.90 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
UPMC for Life HMO Deductible with Rx (HMO)
|
$22.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,636.43 |
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 | $7,386.28 |
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 | $7,386.28 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Vibra Health Plan Enhanced Complete (PPO)
|
$26.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,624.90 |
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 | P Q:1 /28Days | $7,306.25 |
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 H5525-006 (PPO)
|
$28.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:1 /28Days | $7,140.89 |
Browse Plan Formulary |
HumanaChoice R0923-002 (Regional PPO)
|
$29.60 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:1 /28Days | $7,306.25 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.10 |
$445 | No | 5 |
Tier 5 |
$0.00 | $0.00 | P | $7,431.50 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,958.52 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,420.74 |
Browse Plan Formulary |
Community Blue Medicare PPO Distinct (PPO)
|
$35.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,958.52 |
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 | None | $6,958.52 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$37.20 |
$445 | No | 5 |
Tier 5 |
25% | 25% | P | $7,431.50 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$37.40 |
$445 | No | 2 |
Brand |
25% | 25% | P | $6,865.72 |
Browse Plan Formulary |
Gateway Health Medicare Assured Diamond (HMO D-SNP)
|
$37.50 |
$445 | No | 5 |
Specialty Tier |
25% | n/a | P | $6,602.04 |
Browse Plan Formulary |
Gateway Health Medicare Assured Ruby (HMO D-SNP)
|
$37.50 |
$445 | No | 5 |
Specialty Tier |
25% | n/a | P | $6,602.04 |
Browse Plan Formulary |
Geisinger Gold Secure Rx (HMO D-SNP)
|
$37.50 |
$445 | No | 1 |
Tier 1 |
15% | 15% | P | $6,680.00 |
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 |
Health Partners Medicare Prime (HMO-POS)
|
$37.50 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,767.68 |
Browse Plan Formulary |
Health Partners Medicare Special (HMO D-SNP)
|
$37.50 |
$445 | No | 1 |
Tier 1 |
$0.00 | $0.00 | P | $6,767.68 |
Browse Plan Formulary |
UPMC for Life Complete Care (HMO D-SNP)
|
$37.50 |
$445 | No | 5 |
Specialty Tier |
25% | n/a | P | $6,420.74 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,680.00 |
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 | $6,636.43 |
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 | $6,680.00 |
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 | $6,706.95 |
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 Classic (PPO)
|
$49.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,624.90 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
BlueJourney Value (HMO)
|
$51.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,624.90 |
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 | $7,386.28 |
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 | $6,420.74 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Freedom Blue PPO ValueRx (PPO)
|
$70.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,420.74 |
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 | $6,636.43 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,706.95 |
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 | $6,680.00 |
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 | $6,706.95 |
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 | $6,624.90 |
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:1 /28Days | $7,306.25 |
Browse Plan Formulary |
Geisinger Gold Classic Advantage Rx (HMO)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $6,680.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $6,706.95 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $6,706.95 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $6,706.95 |
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)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $6,706.95 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Geisinger Gold Classic Advantage Rx (HMO)
|
$136.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P | $6,706.95 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueJourney Prime (PPO)
|
$171.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,624.90 |
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 | None | $6,420.74 |
Browse Plan Formulary |
Freedom Blue PPO Deluxe (PPO)
|
$289.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $6,420.74 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced (HMO)
|
$302.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $6,636.43 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |