ARNUITY ELLIPTA 50 MCG INH BLST W/DEV (units ) (NDC: 00173088810)
2021 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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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 Freedom Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Freedom Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Freedom Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Freedom Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Focus (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Focus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Focus (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Focus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
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 SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.00 | $111.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.00 | $111.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
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 |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Care On Site (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Care On Site (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
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 |
Anthem MediBlue Care On Site (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Care On Site (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Diabetes Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Diabetes Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Diabetes Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Diabetes Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue ESRD Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue ESRD Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue ESRD Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue ESRD Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Heart Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Heart Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
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 |
Anthem MediBlue Heart Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Heart Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Lung Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Lung Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Lung Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Lung Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days | $192.90 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days | $192.90 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $192.90 |
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 |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $192.90 |
Browse Plan Formulary |
Anthem MediBlue StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Value Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Value Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$37.50 | $75.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
AVA (HMO)
![Email Prescription and/or Health Benefit details for AVA (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $180.90 |
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 |
AVA (HMO)
![Email Prescription and/or Health Benefit details for AVA (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $180.90 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$38.00 | $95.00 | Q:30 /30Days | $178.50 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$38.00 | $95.00 | Q:30 /30Days | $178.50 |
Browse Plan Formulary |
Blue Shield 65 Plus Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:30 /30Days | $178.20 |
Browse Plan Formulary |
Blue Shield 65 Plus Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:30 /30Days | $178.20 |
Browse Plan Formulary |
Blue Shield Inspire (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Inspire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:30 /30Days | $178.50 |
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 Shield Inspire (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Inspire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:30 /30Days | $178.50 |
Browse Plan Formulary |
Blue Shield Vital (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Vital (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:30 /30Days | $178.50 |
Browse Plan Formulary |
Blue Shield Vital (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Vital (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:30 /30Days | $178.50 |
Browse Plan Formulary |
Brand New Day Bridges Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Bridges Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Classic Care I Plan (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Care I Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
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 |
Brand New Day Classic Care I Plan (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Care I Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Classic Care II Plan (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Care II Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Classic Care II Plan (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Care II Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Embrace Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary select insulin pay $9-$20 copay but not this drug |
Brand New Day Embrace Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary select insulin pay $9-$20 copay but not this drug |
Brand New Day Embrace Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary select insulin pay $9-$20 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 |
Brand New Day Embrace Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary select insulin pay $9-$20 copay but not this drug |
Brand New Day Harmony Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Harmony Care Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Care Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Select Care I Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Select Care I Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Select Care I Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Select Care I Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Central Health Focus Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Central Health Focus Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $178.80 |
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 |
Central Health Focus Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Central Health Focus Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Medicare Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Medicare Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Clever Care Longevity Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Clever Care Longevity Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $178.80 |
Browse Plan Formulary select insulin pay $5-$35 copay but not this drug |
Clever Care Longevity Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Clever Care Longevity Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $178.80 |
Browse Plan Formulary select insulin pay $5-$35 copay but not this drug |
Clever Care Longevity Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Clever Care Longevity Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $178.80 |
Browse Plan Formulary select insulin pay $5-$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 |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | None | $179.10 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | None | $179.10 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:30 /30Days | $193.80 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:30 /30Days | $193.80 |
Browse Plan Formulary |
Health Net Jade (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:30 /30Days | $193.80 |
Browse Plan Formulary |
Health Net Jade (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:30 /30Days | $193.80 |
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 |
Heart & Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Heart & Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $180.90 |
Browse Plan Formulary |
Heart & Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Heart & Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $180.90 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$35.00 | $70.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Imperial Dynamic Plan (HMO)
![Email Prescription and/or Health Benefit details for Imperial Dynamic Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $186.60 |
Browse Plan Formulary |
Imperial Dynamic Plan (HMO)
![Email Prescription and/or Health Benefit details for Imperial Dynamic Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $186.60 |
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 |
Imperial Senior Value (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Imperial Senior Value (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $186.90 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Imperial Senior Value (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Imperial Senior Value (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $186.90 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Imperial Traditional (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $186.90 |
Browse Plan Formulary |
Imperial Traditional (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $186.90 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None | $186.60 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | None | $186.60 |
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 |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:30 /30Days | $182.70 |
Browse Plan Formulary |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:30 /30Days | $182.70 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
My Choice (HMO)
![Email Prescription and/or Health Benefit details for My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $180.90 |
Browse Plan Formulary |
My Choice (HMO)
![Email Prescription and/or Health Benefit details for My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $180.90 |
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 |
PHP (HMO C-SNP)
![Email Prescription and/or Health Benefit details for PHP (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$445 |
No |
2 |
Preferred Brand |
15% | n/a | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
PHP (HMO C-SNP)
![Email Prescription and/or Health Benefit details for PHP (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$445 |
No |
2 |
Preferred Brand |
15% | n/a | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Platinum (HMO)
![Email Prescription and/or Health Benefit details for Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $180.90 |
Browse Plan Formulary |
Platinum (HMO)
![Email Prescription and/or Health Benefit details for Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $180.90 |
Browse Plan Formulary |
smartHMO (HMO)
![Email Prescription and/or Health Benefit details for smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $181.50 |
Browse Plan Formulary |
smartHMO (HMO)
![Email Prescription and/or Health Benefit details for smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$30.00 | $75.00 | Q:30 /30Days | $181.50 |
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 |
WellCare Best (HMO)
![Email Prescription and/or Health Benefit details for WellCare Best (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$25.00 | $50.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
WellCare Best (HMO)
![Email Prescription and/or Health Benefit details for WellCare Best (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$25.00 | $50.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
WellCare Dividend (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
WellCare Dividend (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
WellCare Freedom (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Freedom (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.20 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
WellCare Freedom (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Freedom (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.20 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $194.70 |
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 |
WellCare Plus (HMO)
![Email Prescription and/or Health Benefit details for WellCare Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$6.70 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
WellCare Plus (HMO)
![Email Prescription and/or Health Benefit details for WellCare Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$6.70 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.20 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $192.90 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.20 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $192.90 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:30 /30Days | $194.10 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:30 /30Days | $194.10 |
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 |
AARP Medicare Advantage SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $195.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
CalPlus (HMO)
![Email Prescription and/or Health Benefit details for CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.10 |
$445 |
No |
3 |
Preferred Brand |
23% | 23% | Q:30 /30Days | $180.60 |
Browse Plan Formulary |
CalPlus (HMO)
![Email Prescription and/or Health Benefit details for CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.10 |
$445 |
No |
3 |
Preferred Brand |
23% | 23% | Q:30 /30Days | $180.60 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.40 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $194.10 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.40 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $194.10 |
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 |
UnitedHealthcare Medicare Advantage Assure (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Assure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$445 |
No |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Assure (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Assure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$445 |
No |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $195.90 |
Browse Plan Formulary |
Anthem MediBlue Connect (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Connect (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$445 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.40 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$445 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.10 |
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 |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$445 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$445 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.40 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$445 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$445 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Health Net Sapphire Premier (HMO)
![Email Prescription and/or Health Benefit details for Health Net Sapphire Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
Health Net Sapphire Premier (HMO)
![Email Prescription and/or Health Benefit details for Health Net Sapphire Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.70 |
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 |
Health Net Amber II (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Amber II (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.60 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Health Net Amber II (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Amber II (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.60 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Health Net Sapphire Premier II (HMO)
![Email Prescription and/or Health Benefit details for Health Net Sapphire Premier II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
Health Net Sapphire Premier II (HMO)
![Email Prescription and/or Health Benefit details for Health Net Sapphire Premier II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.70 |
Browse Plan Formulary |
Health Net Amber I (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Amber I (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.80 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Health Net Amber I (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Amber I (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.80 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
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 |
Health Net Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.50 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Health Net Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.50 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.90 |
$0 |
No |
4 |
Tier 4 |
$100.00 | $200.00 | None | $186.60 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.90 |
$0 |
No |
4 |
Tier 4 |
$100.00 | $200.00 | None | $186.60 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | None | $186.60 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | None | $186.60 |
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 |
Anthem MediBlue Extra (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $193.80 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $193.80 |
Browse Plan Formulary |
Brand New Day Bridges Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Bridges Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Bridges Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Classic Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Classic Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day Classic Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
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 |
Brand New Day Dual Access Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Dual Access Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Dual Access Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Dual Access Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Embrace Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Embrace Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Embrace Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Embrace Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Embrace Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
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 |
Brand New Day Harmony Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Harmony Choice Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Harmony Choice Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Select Choice I Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Select Choice I Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Brand New Day Select Choice I Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Brand New Day Select Choice I Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $180.30 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Central Health Medi-Medi Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Central Health Medi-Medi Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $178.80 |
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 |
Central Health Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Clever Care Balance Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Clever Care Balance Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$435 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Clever Care Balance Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Clever Care Balance Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$435 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Clever Care Balance Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Clever Care Balance Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$435 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $178.80 |
Browse Plan Formulary |
Imperial Traditional Plus (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $186.90 |
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 |
Imperial Traditional Plus (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $186.90 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$445 |
No |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $179.10 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$89.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$89.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $194.40 |
Browse Plan Formulary |