PROLIA 60MG/ML INJECTION (1 ML X SYR CRTN ) (NDC: 55513071001)
2021 Medicare Prescription Drug Plan (MAPD) Information
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage Plan 7 (HMO)
|
$0.00 |
$175 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1 /180Days | $1,443.47 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Walgreens (PPO)
|
$0.00 |
$225 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1 /180Days | $1,413.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Silver (PPO)
|
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,428.29 |
Browse Plan Formulary |
Aetna Medicare Premier (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,428.69 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,427.72 |
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 Essential (HMO)
|
$0.00 |
$60 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:1 /180Days | $1,420.66 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:1 /180Days | $1,420.58 |
Browse Plan Formulary |
Anthem MediBlue Prime Select (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:1 /180Days | $1,414.85 |
Browse Plan Formulary |
Bright Advantage University Hospitals (HMO)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:1 /180Days | $1,371.85 |
Browse Plan Formulary |
Bright Advantage University Hospitals Choice (PPO)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:1 /180Days | $1,371.85 |
Browse Plan Formulary |
Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,317.27 |
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 |
CareSource Advantage Zero Premium (HMO)
|
$0.00 |
$175 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | P Q:1 /180Days | $1,342.34 |
Browse Plan Formulary |
CareSource MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:1 /180Days | $1,333.41 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:1 /180Days | $1,475.23 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:1 /180Days | $1,475.23 |
Browse Plan Formulary |
Devoted Health Core (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:1 /180Days | $1,327.49 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Devoted Health Saver (HMO)
|
$0.00 |
$200 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,327.49 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Cleveland Clinic Preferred (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,432.32 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H6622-022 (HMO)
|
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,436.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5525-042 (PPO)
|
$0.00 |
$250 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,424.43 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,324.99 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
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 |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
Browse Plan Formulary |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
Browse Plan Formulary |
Paramount Elite - Standard Medical & Drug (HMO)
|
$0.00 |
$50 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:1 /180Days | $1,317.29 |
Browse Plan Formulary |
PrimeTime Health Plan Aultimate (HMO-POS)
|
$0.00 |
$200 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $1,326.70 |
Browse Plan Formulary |
SummaCare Medicare Topaz (HMO)
|
$0.00 |
$150 |
No |
3 |
Preferred Brand |
$47.00 | $117.50 | S Q:1 /180Days | $1,340.14 |
Browse Plan Formulary |
UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:1 /180Days | $1,443.82 |
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 Dividend (HMO)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /180Days | $1,430.55 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:1 /180Days | $1,431.34 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$15.00 |
$200 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,425.74 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-106 (PPO)
|
$15.00 |
$125 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,428.82 |
Browse Plan Formulary |
Anthem MediBlue Preferred Plus (HMO)
|
$19.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:1 /180Days | $1,420.89 |
Browse Plan Formulary |
MedMutual Advantage Secure (HMO)
|
$20.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
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 |
MedMutual Advantage Secure (HMO)
|
$20.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
Browse Plan Formulary |
AARP Medicare Advantage Plan 1 (HMO)
|
$21.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:1 /180Days | $1,443.47 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Allwell Dual Medicare (HMO D-SNP)
|
$21.10 |
$150 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /180Days | $1,430.74 |
Browse Plan Formulary |
Devoted Health Prime (HMO)
|
$22.80 |
$150 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:1 /180Days | $1,327.49 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier Plus 2 (Regional PPO)
|
$25.30 |
$190 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,428.46 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$25.30 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:1 /180Days | $1,420.58 |
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 Assure 1 (HMO D-SNP)
|
$26.20 |
$220 |
No |
4 |
Non-Preferred Drug |
35% | 35% | Q:1 /180Days | $1,429.44 |
Browse Plan Formulary |
CareSource Advantage (HMO)
|
$26.60 |
$100 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | P Q:1 /180Days | $1,342.34 |
Browse Plan Formulary |
Aetna Medicare Assure (HMO D-SNP)
|
$27.50 |
$130 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,428.79 |
Browse Plan Formulary |
Paramount Elite - Prime Medical & Drug (HMO)
|
$28.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:1 /180Days | $1,317.29 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
SummaCare Medicare Garnet (HMO)
|
$29.00 |
$0 |
No |
3 |
Preferred Brand |
$44.00 | $110.00 | S Q:1 /180Days | $1,327.55 |
Browse Plan Formulary |
SummaCare Medicare Garnet (HMO)
|
$29.00 |
$0 |
No |
3 |
Preferred Brand |
$44.00 | $110.00 | S Q:1 /180Days | $1,358.45 |
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 Dual Advantage (HMO D-SNP)
|
$29.80 |
$445 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:1 /180Days | $1,420.58 |
Browse Plan Formulary |
CareSource Dual Advantage (HMO D-SNP)
|
$29.80 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | P Q:1 /180Days | $1,342.34 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)
|
$29.80 |
$420 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,424.86 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$29.80 |
$445 |
No |
4 |
Non-Preferred Drug |
34% | 34% | Q:1 /180Days | $1,317.22 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$29.80 |
$445 |
No |
4 |
Non-Preferred Drug |
34% | 34% | Q:1 /180Days | $1,317.22 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
|
$29.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | Q:1 /180Days | $1,443.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare Dual Complete LP1 (HMO D-SNP)
|
$29.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | Q:1 /180Days | $1,443.67 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$29.80 |
$445 |
No |
4 |
Tier 4 |
25% | 25% | Q:1 /180Days | $1,443.29 |
Browse Plan Formulary |
Valor Health Plan (HMO I-SNP)
|
$29.80 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | None | $1,371.97 |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
|
$29.80 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:1 /180Days | $1,431.34 |
Browse Plan Formulary |
Bright Advantage University Hospitals Choice Plus (PPO)
|
$34.00 |
$445 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:1 /180Days | $1,371.85 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,324.99 |
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 |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
Browse Plan Formulary |
The Health Plan SecureCare - Option II (HMO)
|
$35.00 |
$100 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:1 /180Days | $1,337.81 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
|
$36.10 |
$200 |
No |
4 |
Non-Preferred Drug |
41% | 41% | P Q:1 /180Days | $1,420.58 |
Browse Plan Formulary |
The Health Plan SecureCare SNP (HMO D-SNP)
|
$37.00 |
$445 |
No |
3 |
Tier 3 |
15% | 15% | P Q:1 /180Days | $1,333.06 |
Browse Plan Formulary |
Aetna Medicare Premier Plus 1 (Regional PPO)
|
$38.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,428.46 |
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 |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,324.99 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
|
$39.00 |
$380 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,424.43 |
Browse Plan Formulary |
PrimeTime Health Plan Classic (HMO-POS)
|
$39.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $1,326.70 |
Browse Plan Formulary |
SummaCare Medicare Ruby (HMO)
|
$43.00 |
$0 |
No |
3 |
Preferred Brand |
$44.00 | $110.00 | S Q:1 /180Days | $1,339.47 |
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 |
Humana Gold Plus H6622-011 (HMO)
|
$46.00 |
$195 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,436.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Anthem MediBlue Access (PPO)
|
$65.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:1 /180Days | $1,415.51 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$65.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:1 /180Days | $1,421.49 |
Browse Plan Formulary |
Paramount Elite - Enhanced Medical & Drug (HMO)
|
$68.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:1 /180Days | $1,317.29 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,324.99 |
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 |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
Browse Plan Formulary |
HumanaChoice H5216-024 (PPO)
|
$75.00 |
$100 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:1 /180Days | $1,432.09 |
Browse Plan Formulary |
SummaCare Medicare Sapphire (HMO-POS)
|
$76.00 |
$0 |
No |
3 |
Preferred Brand |
$44.00 | $110.00 | S Q:1 /180Days | $1,339.47 |
Browse Plan Formulary |
The Health Plan SecureChoice - Option II (PPO)
|
$79.00 |
$100 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:1 /180Days | $1,337.81 |
Browse Plan Formulary |
PrimeTime Health Plan Plus (HMO-POS)
|
$89.00 |
$100 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $1,326.70 |
Browse Plan Formulary |
Humana Gold Plus H6622-019 (HMO)
|
$90.00 |
$125 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | P Q:1 /180Days | $1,424.82 |
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 |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,324.99 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
Browse Plan Formulary |
AARP Medicare Advantage Plan 3 (HMO)
|
$111.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:1 /180Days | $1,443.33 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier 2 (PPO)
|
$124.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,428.19 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,347.46 |
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 |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,324.99 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | P Q:1 /180Days | $1,339.76 |
Browse Plan Formulary |
Aetna Medicare Premier 1 (PPO)
|
$140.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:1 /180Days | $1,428.88 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
|
$155.00 |
$100 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | P Q:1 /180Days | $1,424.40 |
Browse Plan Formulary |
SummaCare Medicare Emerald (HMO-POS)
|
$180.00 |
$0 |
No |
3 |
Preferred Brand |
$39.00 | $95.70 | S Q:1 /180Days | $1,339.69 |
Browse Plan Formulary |