TRUMENBA 120 MCG/0.5 ML VACCIN Syringe (NDC: 00005010005)
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 |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:1 /1Days | $1,006.38 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Walgreens (PPO)
|
$0.00 |
$225 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:1 /1Days | $1,006.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$150* |
No |
3* |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
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 |
Allwell Medicare (HMO)
|
$0.00 |
$75 |
No |
3 |
Preferred Brand |
$37.00 | $111.00 | None | $994.95 |
Browse Plan Formulary |
Allwell Medicare Boost (HMO)
|
$0.00 |
$75 |
No |
3 |
Preferred Brand |
$37.00 | $111.00 | None | $994.95 |
Browse Plan Formulary |
Anthem MediBlue Essential (HMO)
|
$0.00 |
$60 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $974.55 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $974.55 |
Browse Plan Formulary |
Anthem MediBlue Prime Select (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $964.77 |
Browse Plan Formulary |
Bright Advantage University Hospitals (HMO)
|
$0.00 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $955.23 |
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 |
Bright Advantage University Hospitals Choice (PPO)
|
$0.00 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $955.23 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
|
$0.00 |
$150 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $913.86 |
Browse Plan Formulary |
CareSource MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | None | $917.10 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $964.95 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $964.95 |
Browse Plan Formulary |
Devoted Health Core (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $105.00 | None | $925.44 |
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 |
Devoted Health Saver (HMO)
|
$0.00 |
$200 |
No |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $925.44 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Cleveland Clinic Preferred (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $995.97 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H6622-014 (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $991.29 |
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 | None | $988.92 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $921.72 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.37 |
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 Classic (HMO)
|
$0.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.73 |
Browse Plan Formulary |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $921.72 |
Browse Plan Formulary |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.73 |
Browse Plan Formulary |
Paramount Elite - Standard Medical & Drug (HMO)
|
$0.00 |
$50 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $917.49 |
Browse Plan Formulary |
PrimeTime Health Plan Aultimate (HMO-POS)
|
$0.00 |
$200 |
No |
3 |
Preferred Brand |
$42.00 | $125.00 | None | $918.54 |
Browse Plan Formulary |
SummaCare Medicare Topaz (HMO)
|
$0.00 |
$150 |
No |
6 |
Vaccines |
$0.00 | $0.00 | None | $1,132.02 |
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 Connected for MyCareOhio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | Q:1 /1Days | $1,006.80 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $997.11 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $999.00 |
Browse Plan Formulary |
Allwell Medicare Complement (HMO)
|
$9.60 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $997.80 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$15.00 |
$200 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $988.29 |
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 | None | $989.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem MediBlue Preferred Plus (HMO)
|
$19.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $976.11 |
Browse Plan Formulary |
Humana Gold Plus H6622-070 (HMO)
|
$20.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $991.29 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MedMutual Advantage Secure (HMO)
|
$20.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $921.72 |
Browse Plan Formulary |
MedMutual Advantage Secure (HMO)
|
$20.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.73 |
Browse Plan Formulary |
AARP Medicare Advantage Plan 1 (HMO)
|
$21.00 |
$150* |
No |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:1 /1Days | $1,006.38 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Allwell Dual Medicare (HMO D-SNP)
|
$21.10 |
$150 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $996.60 |
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 |
CareSource Advantage (HMO)
|
$21.60 |
$75 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $913.86 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
|
$22.00 |
$445 |
No |
3 |
Tier 3 |
25% | 25% | Q:1 /1Days | $1,005.81 |
Browse Plan Formulary |
Devoted Health Prime (HMO)
|
$22.80 |
$150 |
No |
3 |
Preferred Brand |
$42.00 | $105.00 | None | $925.44 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier Plus 2 (Regional PPO)
|
$25.30 |
$190 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$25.30 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $974.55 |
Browse Plan Formulary |
Aetna Medicare Assure 1 (HMO D-SNP)
|
$26.20 |
$220 |
No |
3 |
Preferred Brand |
25% | 25% | None | $996.18 |
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 (HMO D-SNP)
|
$27.50 |
$130 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
Browse Plan Formulary |
Paramount Elite - Prime Medical & Drug (HMO)
|
$28.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $917.49 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
SummaCare Medicare Garnet (HMO)
|
$29.00 |
$0 |
No |
6 |
Vaccines |
$0.00 | $0.00 | None | $1,132.02 |
Browse Plan Formulary |
SummaCare Medicare Garnet (HMO)
|
$29.00 |
$0 |
No |
6 |
Vaccines |
$0.00 | $0.00 | None | $1,132.02 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO D-SNP)
|
$29.80 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $974.55 |
Browse Plan Formulary |
CareSource Dual Advantage (HMO D-SNP)
|
$29.80 |
$445 |
No |
3 |
Preferred Brand |
25% | 25% | None | $913.86 |
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 SNP-DE H6622-015 (HMO D-SNP)
|
$29.80 |
$420 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $988.47 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$29.80 |
$445 |
No |
3 |
Preferred Brand |
$44.00 | $132.00 | None | $918.12 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$29.80 |
$445 |
No |
3 |
Preferred Brand |
$44.00 | $132.00 | None | $918.12 |
Browse Plan Formulary |
Provider Partners Ohio Advantage Plan (HMO I-SNP)
|
$29.80 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | None | $955.23 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO D-SNP)
|
$29.80 |
$445 |
No |
3 |
Tier 3 |
15% | 15% | Q:1 /1Days | $1,006.29 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$29.80 |
$445 |
No |
3 |
Tier 3 |
25% | 25% | Q:1 /1Days | $1,005.93 |
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 |
Valor Health Plan (HMO I-SNP)
|
$29.80 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | None | $965.19 |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
|
$29.80 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $999.00 |
Browse Plan Formulary |
Bright Advantage University Hospitals Choice Plus (PPO)
|
$34.00 |
$445 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $955.23 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $921.72 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.37 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.73 |
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 |
The Health Plan SecureCare - Option II (HMO)
|
$35.00 |
$100 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $927.63 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
|
$36.10 |
$200 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $974.55 |
Browse Plan Formulary |
The Health Plan SecureCare SNP (HMO D-SNP)
|
$37.00 |
$445 |
No |
3 |
Tier 3 |
15% | 15% | None | $925.11 |
Browse Plan Formulary |
Aetna Medicare Premier Plus 1 (Regional PPO)
|
$38.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $921.72 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.37 |
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 | None | $926.73 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
|
$39.00 |
$380 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $988.92 |
Browse Plan Formulary |
PrimeTime Health Plan Classic (HMO-POS)
|
$39.00 |
$150 |
No |
3 |
Preferred Brand |
$42.00 | $125.00 | None | $918.54 |
Browse Plan Formulary |
SummaCare Medicare Ruby (HMO)
|
$43.00 |
$0 |
No |
6 |
Vaccines |
$0.00 | $0.00 | None | $1,132.02 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$55.00 |
$0 |
No |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $975.30 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$65.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $974.22 |
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 Access (PPO)
|
$65.00 |
$0 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $973.71 |
Browse Plan Formulary |
Paramount Elite - Enhanced Medical & Drug (HMO)
|
$68.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $917.49 |
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 | None | $921.72 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.37 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.73 |
Browse Plan Formulary |
HumanaChoice H5216-024 (PPO)
|
$75.00 |
$100 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $995.97 |
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 |
SummaCare Medicare Sapphire (HMO-POS)
|
$76.00 |
$0 |
No |
6 |
Vaccines |
$0.00 | $0.00 | None | $1,132.02 |
Browse Plan Formulary |
The Health Plan SecureChoice - Option II (PPO)
|
$79.00 |
$100 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $927.63 |
Browse Plan Formulary |
Anthem MediBlue Access Plus (PPO)
|
$89.00 |
$40 |
No |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $971.16 |
Browse Plan Formulary |
PrimeTime Health Plan Plus (HMO-POS)
|
$89.00 |
$100 |
No |
3 |
Preferred Brand |
$42.00 | $125.00 | None | $918.54 |
Browse Plan Formulary |
Humana Gold Plus H6622-019 (HMO)
|
$90.00 |
$125 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | None | $988.14 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $921.72 |
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 |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.37 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.73 |
Browse Plan Formulary |
AARP Medicare Advantage Plan 3 (HMO)
|
$111.00 |
$0 |
No |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:1 /1Days | $1,005.75 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier 2 (PPO)
|
$124.00 |
$0 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $921.72 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
3 |
Preferred Brand |
$42.00 | $110.00 | None | $926.37 |
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 | None | $926.73 |
Browse Plan Formulary |
Aetna Medicare Premier 1 (PPO)
|
$140.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $141.00 | None | $996.18 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
|
$155.00 |
$100 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | None | $988.80 |
Browse Plan Formulary |
SummaCare Medicare Emerald (HMO-POS)
|
$180.00 |
$0 |
No |
6 |
Vaccines |
$0.00 | $0.00 | None | $1,132.02 |
Browse Plan Formulary |