DRIZALMA SPRINKLE DR 20 MG CAPSULE (30 units ) (NDC: 47335061630)
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 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | S Q:60 /30Days | $199.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | S Q:60 /30Days | $199.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice Plan 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Choice Plan 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:60 /30Days | $199.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Focus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Focus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | S Q:60 /30Days | $199.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Choice (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$195 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $201.30 |
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 |
Aetna Medicare Premier (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $201.30 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $201.30 |
Browse Plan Formulary |
Aetna Medicare Select (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P Q:60 /30Days | $201.30 |
Browse Plan Formulary select insulin pay $20 copay but not this drug |
BayCarePlus Complete (HMO)
![Email Prescription and/or Health Benefit details for BayCarePlus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | S Q:60 /30Days | $189.90 |
Browse Plan Formulary |
BayCarePlus Rewards (HMO)
![Email Prescription and/or Health Benefit details for BayCarePlus Rewards (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$100.00 | $275.00 | S Q:60 /30Days | $189.90 |
Browse Plan Formulary |
BlueMedicare Classic (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:60 /30Days | $188.40 |
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 |
BlueMedicare Premier (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$80.00 | $240.00 | Q:60 /30Days | $188.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Saver (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Saver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days | $188.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Value (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days | $188.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
CareComplete (HMO C-SNP)
![Email Prescription and/or Health Benefit details for CareComplete (HMO C-SNP)](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 |
$85.00 | $245.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$60.00 | $170.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$60.00 | $170.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $20-$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 |
CareOne PLUS (HMO)
![Email Prescription and/or Health Benefit details for CareOne PLUS (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 |
$55.00 | $155.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
CareOne PLUS (HMO)
![Email Prescription and/or Health Benefit details for CareOne PLUS (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 |
$55.00 | $155.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:60 /30Days | $196.20 |
Browse Plan Formulary |
Cigna Preferred Savings Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Savings Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:60 /30Days | $196.20 |
Browse Plan Formulary |
Devoted Health Core Greater Tampa Bay (HMO)
![Email Prescription and/or Health Benefit details for Devoted Health Core Greater Tampa Bay (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:60 /30Days | $200.40 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Devoted Health Essentials Polk (HMO)
![Email Prescription and/or Health Benefit details for Devoted Health Essentials Polk (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:60 /30Days | $200.40 |
Browse Plan Formulary select insulin pay $0 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 |
Freedom Platinum Plan Rx (HMO)
![Email Prescription and/or Health Benefit details for Freedom Platinum Plan Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$70.00 | $140.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Freedom VIP Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$60.00 | $120.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom VIP Rewards (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Rewards (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$90.00 | $180.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Freedom VIP Savings (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$80.00 | $160.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary select insulin pay $0-$10 copay but not this drug |
Freedom VIP Savings COPD (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings COPD (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$60.00 | $120.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Humana Gold Plus H1036-230 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-230 (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 |
$95.00 | $275.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $15-$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 Gold Plus H1036-268 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-268 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
HumanaChoice Florida H5216-072 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H5216-072 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-074 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Optimum Diamond Rewards (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$80.00 | $160.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Optimum Diamond Rewards COPD (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Optimum Diamond Rewards COPD (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$80.00 | $160.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
![Email Prescription and/or Health Benefit details for Optimum Platinum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$85.00 | $170.00 | Q:180 /30Days | $199.20 |
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 |
Simply Level (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Simply Level (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$40.00 | n/a | Q:180 /30Days | $199.50 |
Browse Plan Formulary |
Simply More (HMO)
![Email Prescription and/or Health Benefit details for Simply More (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$55.00 | n/a | Q:180 /30Days | $199.50 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:60 /30Days | $198.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:60 /30Days | $198.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:60 /30Days | $198.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:60 /30Days | $198.60 |
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 |
WellCare Champion (HMO C-SNP)
![Email Prescription and/or Health Benefit details for WellCare Champion (HMO C-SNP)](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 |
$80.00 | $160.00 | P Q:60 /30Days | $204.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
WellCare Dividend Prime (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend Prime (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 |
$80.00 | $160.00 | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
WellCare Elite (HMO)
![Email Prescription and/or Health Benefit details for WellCare Elite (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 |
$75.00 | $150.00 | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
WellCare Guardian (HMO C-SNP)
![Email Prescription and/or Health Benefit details for WellCare Guardian (HMO C-SNP)](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 |
$75.00 | $150.00 | P Q:60 /30Days | $204.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
WellCare Premier (PPO)
![Email Prescription and/or Health Benefit details for WellCare Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
Simply Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Simply Care (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.00 |
$445 |
No |
4 |
Non-Preferred Brand |
25% | n/a | Q:180 /30Days | $199.50 |
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 |
CareNeeds PLUS (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CareNeeds PLUS (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.00 |
$445 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Cigna TotalCare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$445 |
No |
4 |
Non-Preferred Drug |
44% | 44% | Q:60 /30Days | $196.20 |
Browse Plan Formulary |
Cigna Primary Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Primary Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.90 |
$445 |
No |
4 |
Non-Preferred Drug |
39% | 39% | Q:60 /30Days | $196.20 |
Browse Plan Formulary |
Humana Fully Integrated H1036-283 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Fully Integrated H1036-283 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$445 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$445 |
No |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Allwell Dual Medicare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$445 |
No |
4 |
Non-Preferred Drug |
47% | 47% | P Q:60 /30Days | $204.00 |
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 |
Aetna Medicare Assure Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$250 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $201.60 |
Browse Plan Formulary |
BayCarePlus Signature (HMO)
![Email Prescription and/or Health Benefit details for BayCarePlus Signature (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | S Q:60 /30Days | $189.90 |
Browse Plan Formulary |
WellCare Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.10 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
WellCare Reserve (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Reserve (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.60 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.40 |
$445 |
No |
4 |
Non-Preferred Drug |
45% | 45% | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
WellCare Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.40 |
$445 |
No |
4 |
Non-Preferred Drug |
45% | 45% | P Q:60 /30Days | $204.00 |
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 |
WellCare Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.40 |
$445 |
No |
4 |
Non-Preferred Drug |
45% | 45% | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
WellCare Liberty (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Liberty (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
Aetna Medicare Assure (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$250 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $201.60 |
Browse Plan Formulary |
Allwell Medicare Nurture (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Allwell Medicare Nurture (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days | $204.00 |
Browse Plan Formulary |
BlueMedicare Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for BlueMedicare Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
$92.00 | $276.00 | Q:60 /30Days | $188.10 |
Browse Plan Formulary |
Devoted Health Dual Greater Tampa Bay (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Devoted Health Dual Greater Tampa Bay (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $200.40 |
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 |
Devoted Health Prime Greater Tampa Bay (HMO)
![Email Prescription and/or Health Benefit details for Devoted Health Prime Greater Tampa Bay (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $200.40 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Freedom Medi-Medi Full (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Full (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
3 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Partial (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
3 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Longevity Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Longevity Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | S | $192.00 |
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) |
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
33% | 33% | P Q:60 /30Days | $199.80 |
Browse Plan Formulary |
Optimum Emerald Full (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Full (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
3 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:180 /30Days | $199.20 |
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 |
Optimum Emerald Partial (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Partial (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
3 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:180 /30Days | $199.20 |
Browse Plan Formulary |
Simply Comfort (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Simply Comfort (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Non-Preferred Brand |
25% | n/a | Q:180 /30Days | $199.50 |
Browse Plan Formulary |
Simply Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Simply Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Non-Preferred Brand |
$95.00 | n/a | Q:180 /30Days | $200.70 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Assisted Living Plan (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$200 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:60 /30Days | $199.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Choice (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | S Q:60 /30Days | $199.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Choice (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | S Q:60 /30Days | $199.20 |
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 |
UnitedHealthcare Dual Complete LP (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete LP (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | S Q:60 /30Days | $199.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | S Q:60 /30Days | $199.20 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$445 |
No |
4 |
Tier 4 |
25% | 25% | S Q:60 /30Days | $199.20 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-005 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.90 |
$100 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary |
BlueMedicare Choice (Regional PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Choice (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.90 |
$250 |
No |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:60 /30Days | $188.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
WellCare Prime (PPO)
![Email Prescription and/or Health Benefit details for WellCare Prime (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$75.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | P Q:60 /30Days | $204.00 |
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 |
Humana Gold Choice H8145-061 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-061 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$101.00 |
$200 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | P Q:60 /30Days | $194.40 |
Browse Plan Formulary |