ASHLYNA 0.15-0.03-0.01 MG TABLET (91.000 EA ) (NDC: 68462064693)
2021 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage 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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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 |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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 |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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 |
2 |
Generic |
$0.00 | $0.00 | None | $13.50 |
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 |
2 |
Generic |
$0.00 | $0.00 | None | $13.50 |
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 |
2 |
Generic |
$10.00 | $25.00 | None | $16.20 |
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 |
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 |
2 |
Generic |
$10.00 | $25.00 | None | $16.20 |
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 |
2 |
Generic |
$10.00 | $25.00 | None | $16.50 |
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 |
2 |
Generic |
$10.00 | $25.00 | None | $16.50 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $59.40 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $59.40 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None | $60.60 |
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 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 |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None | $60.60 |
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 |
2 |
Generic |
$3.00 | $9.00 | None | $59.10 |
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 |
2 |
Generic |
$3.00 | $9.00 | None | $59.10 |
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 | None | $68.70 |
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 | None | $68.70 |
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 | None | $68.70 |
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 |
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 | None | $68.70 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $237.50 | None | $68.70 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $237.50 | None | $68.70 |
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 |
2 |
Generic |
$5.00 | $10.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$5.00 | $10.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$5.00 | $10.00 | Q:91 /84Days | $20.70 |
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 |
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 |
2 |
Generic |
$5.00 | $10.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$12.00 | $24.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$12.00 | $24.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$9.00 | $18.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$9.00 | $18.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$9.00 | $18.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$9.00 | $18.00 | Q:91 /84Days | $20.70 |
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 |
2* |
Generic |
$10.00 | $20.00 | Q:91 /84Days | $20.70 |
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 |
2* |
Generic |
$10.00 | $20.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$9.00 | $18.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$9.00 | $18.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
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 |
2 |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$5.00 | $10.00 | Q:91 /84Days | $26.10 |
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 |
2 |
Generic |
$5.00 | $10.00 | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$5.00 | $10.00 | Q:91 /84Days | $20.70 |
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 |
1 |
Tier 1 |
0% | 0% | None | $50.10 |
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 |
1 |
Tier 1 |
0% | 0% | None | $50.10 |
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 |
2 |
Generic |
$5.00 | $12.50 | None | $58.50 |
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 |
2 |
Generic |
$5.00 | $12.50 | None | $58.50 |
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 |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:91 /90Days | $17.40 |
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 |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:91 /90Days | $17.40 |
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 |
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 |
2 |
Generic |
$10.00 | $20.00 | None | $15.00 |
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 |
2 |
Generic |
$10.00 | $20.00 | None | $15.00 |
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 |
1 |
Tier 1 |
0% | 0% | None | $16.80 |
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 |
1 |
Tier 1 |
0% | 0% | None | $16.80 |
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 |
1 |
Tier 1 |
0% | 0% | None | $26.40 |
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 |
1 |
Tier 1 |
0% | 0% | None | $26.40 |
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 |
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 |
2 |
Generic |
$5.00 | $12.50 | None | $60.60 |
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 |
2 |
Generic |
$5.00 | $12.50 | None | $60.60 |
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 |
1 |
Generic |
15% | n/a | Q:91 /84Days | $20.70 |
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 |
1 |
Generic |
15% | n/a | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
$3.00 | $7.50 | None | $58.50 |
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 |
2 |
Generic |
$3.00 | $7.50 | None | $58.50 |
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 |
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 |
2 |
Generic |
$10.00 | $25.00 | None | $59.40 |
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 |
2 |
Generic |
$10.00 | $25.00 | None | $59.40 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $59.40 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $59.40 |
Browse Plan Formulary |
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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $9.60 |
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 |
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 |
2 |
Generic |
$14.00 | $42.00 | None | $62.40 |
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 |
2 |
Generic |
$14.00 | $42.00 | None | $62.40 |
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 |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $18.00 |
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 |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $18.00 |
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 |
4 |
Tier 4 |
25% | 25% | None | $11.70 |
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 |
4 |
Tier 4 |
25% | 25% | None | $11.70 |
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 |
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 |
2 |
Tier 2 |
$15.00 | $30.00 | None | $12.60 |
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 |
2 |
Tier 2 |
$15.00 | $30.00 | None | $12.60 |
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 |
2 |
Tier 2 |
15% | 15% | None | $12.60 |
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 |
2 |
Tier 2 |
15% | 15% | None | $12.60 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $60.00 |
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 |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $60.00 |
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 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2* |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
2* |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
2* |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
2* |
Generic |
$0.00 | $0.00 | Q:91 /84Days | $20.70 |
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 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $26.10 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 |
2 |
Generic |
25% | 25% | Q:91 /84Days | $20.70 |
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 | None | $29.10 |
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 | None | $29.10 |
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, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $15.90 |
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 |
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, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $15.90 |
Browse Plan Formulary |