ALPRAZOLAM 0.5 MG TABLET (1000 EA ) (NDC: 00228202996)
2022 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 |
Aetna Medicare Credit Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Credit Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:120 /30Days | $54.00 |
Browse Plan Formulary |
Aetna Medicare Elite Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:120 /30Days | $55.80 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:120 /30Days | $55.80 |
Browse Plan Formulary |
CDPHP $0 Medicare Rx (HMO)
![Email Prescription and/or Health Benefit details for CDPHP $0 Medicare Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$17.00 | $34.00 | Q:150 /30Days | $2.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
CDPHP Vital Rx (PPO)
![Email Prescription and/or Health Benefit details for CDPHP Vital Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$17.00 | $34.00 | Q:150 /30Days | $2.70 |
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 |
EmblemHealth VIP Rx Saver (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Rx Saver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $0.00 | None | $14.40 |
Browse Plan Formulary |
EmblemHealth VIP Rx Saver (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Rx Saver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $0.00 | None | $13.50 |
Browse Plan Formulary |
Highmark Blue Shield Freedom Basic (PPO)
![Email Prescription and/or Health Benefit details for Highmark Blue Shield Freedom Basic (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$14.00 | $35.00 | P | $14.40 |
Browse Plan Formulary |
Highmark Blue Shield Freedom Nation (PPO)
![Email Prescription and/or Health Benefit details for Highmark Blue Shield Freedom Nation (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $30.00 | P | $14.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Highmark Blue Shield Freedom Value (HMO)
![Email Prescription and/or Health Benefit details for Highmark Blue Shield Freedom Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $25.00 | P | $14.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H3533-006 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-006 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$9.00 | $0.00 | Q:120 /30Days | $3.60 |
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 |
HumanaChoice H5970-015 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5970-015 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$9.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5970-018 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5970-018 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$16.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MediGold Essential Care (HMO)
![Email Prescription and/or Health Benefit details for MediGold Essential Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $0.00 | Q:150 /30Days | $2.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MVP Medicare WellSelect with Part D (PPO)
![Email Prescription and/or Health Benefit details for MVP Medicare WellSelect with Part D (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $24.00 | None | $1.80 |
Browse Plan Formulary |
Wellcare Fidelis No Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis No Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $0.00 | Q:150 /30Days | $7.20 |
Browse Plan Formulary |
Wellcare Giveback Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$7.00 | $0.00 | Q:150 /30Days | $5.40 |
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 |
Wellcare No Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:150 /30Days | $5.40 |
Browse Plan Formulary |
Wellcare No Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:150 /30Days | $5.40 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$300* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Wellcare Fidelis Assist (HMO-POS)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis Assist (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.10 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:150 /30Days | $38.70 |
Browse Plan Formulary |
HumanaChoice SNP-DE H5970-020 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for HumanaChoice SNP-DE H5970-020 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.40 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$19.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary |
Wellcare Fidelis Dual Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis Dual Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $0.00 | Q:150 /30Days | $38.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Fidelis Dual Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis Dual Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $0.00 | Q:150 /30Days | $37.80 |
Browse Plan Formulary |
Aetna Medicare Assure Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$425 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:120 /30Days | $54.00 |
Browse Plan Formulary |
HumanaChoice H5970-019 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5970-019 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary |
Humana Gold Plus H3533-013 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-013 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MediGold True Advantage (HMO)
![Email Prescription and/or Health Benefit details for MediGold True Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $0.00 | Q:150 /30Days | $2.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$460 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $0.00 | Q:120 /30Days | $3.60 |
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 |
Wellcare Assist Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Assist Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
44% | 44% | Q:150 /30Days | $52.20 |
Browse Plan Formulary |
Wellcare Dual Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:150 /30Days | $53.10 |
Browse Plan Formulary |
CDPHP Basic RX (HMO)
![Email Prescription and/or Health Benefit details for CDPHP Basic RX (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $30.00 | Q:150 /30Days | $2.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$250* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Empire MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.90 |
$480 |
Some Generics |
2 |
Generic |
$5.00 | $15.00 | Q:120 /30Days | $5.40 |
Browse Plan Formulary |
Empire MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.90 |
$480 |
Some Generics |
2 |
Generic |
$5.00 | $15.00 | Q:120 /30Days | $5.40 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access Open (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
49% | 49% | Q:150 /30Days | $53.10 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:120 /30Days | $2.70 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary |
MVP Medicare Secure with Part D (HMO-POS)
![Email Prescription and/or Health Benefit details for MVP Medicare Secure with Part D (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | None | $1.80 |
Browse Plan Formulary |
CDPHP Flex Rx (PPO)
![Email Prescription and/or Health Benefit details for CDPHP Flex Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$14.00 | $28.00 | Q:150 /30Days | $2.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $30.00 | Q:120 /30Days | $5.40 |
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 |
Empire MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $30.00 | Q:120 /30Days | $5.40 |
Browse Plan Formulary |
MVP DualAccess (HMO D-SNP)
![Email Prescription and/or Health Benefit details for MVP DualAccess (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $1.80 |
Browse Plan Formulary |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $13.50 |
Browse Plan Formulary |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $13.50 |
Browse Plan Formulary |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $13.50 |
Browse Plan Formulary |
EmblemHealth VIP Solutions (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Solutions (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $13.50 |
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 |
Hamaspik Medicare Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Hamaspik Medicare Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:120 /30Days | $9.00 |
Browse Plan Formulary |
Nascentia Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Nascentia Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:120 /30Days | $9.90 |
Browse Plan Formulary |
Nascentia Skilled Nursing Facility (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Nascentia Skilled Nursing Facility (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $9.90 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:120 /30Days | $2.70 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $3.60 |
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 |
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $3.60 |
Browse Plan Formulary |
MVP Medicare Patriot Plan with Part D (PPO)
![Email Prescription and/or Health Benefit details for MVP Medicare Patriot Plan with Part D (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $30.00 | None | $1.80 |
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Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:120 /30Days | $55.80 |
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UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.50 |
$150* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:120 /30Days | $3.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Wellcare Premium Enhanced (PFFS)
![Email Prescription and/or Health Benefit details for Wellcare Premium Enhanced (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:150 /30Days | $6.30 |
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Highmark Blue Shield Freedom Plus (HMO)
![Email Prescription and/or Health Benefit details for Highmark Blue Shield Freedom Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $20.00 | P | $14.40 |
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 |
CDPHP Value Rx (HMO)
![Email Prescription and/or Health Benefit details for CDPHP Value Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$13.00 | $26.00 | Q:150 /30Days | $2.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Empire MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$310* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $30.00 | Q:120 /30Days | $5.40 |
Browse Plan Formulary |
Empire MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$310* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $30.00 | Q:120 /30Days | $5.40 |
Browse Plan Formulary |
MVP Medicare Secure Plus with Part D (HMO-POS)
![Email Prescription and/or Health Benefit details for MVP Medicare Secure Plus with Part D (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $30.00 | None | $1.80 |
Browse Plan Formulary |
Wellcare Premium Ultra Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Premium Ultra Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$121.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$5.00 | $0.00 | Q:150 /30Days | $5.40 |
Browse Plan Formulary |
Highmark Blue Shield Senior Blue 652 (HMO)
![Email Prescription and/or Health Benefit details for Highmark Blue Shield Senior Blue 652 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$124.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $25.00 | P | $14.40 |
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 |
MVP Medicare WellSelect Plus with Part D (PPO)
![Email Prescription and/or Health Benefit details for MVP Medicare WellSelect Plus with Part D (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $1.80 |
Browse Plan Formulary |
CDPHP Choice Rx (HMO)
![Email Prescription and/or Health Benefit details for CDPHP Choice Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$131.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$11.00 | $22.00 | Q:150 /30Days | $2.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MVP Medicare Preferred Gold with Part D (HMO-POS)
![Email Prescription and/or Health Benefit details for MVP Medicare Preferred Gold with Part D (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$140.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $1.80 |
Browse Plan Formulary |
Wellcare Premium Ultra (PFFS)
![Email Prescription and/or Health Benefit details for Wellcare Premium Ultra (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$156.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$5.00 | $0.00 | Q:150 /30Days | $6.30 |
Browse Plan Formulary |
Highmark Blue Shield Forever Blue 770 (PPO)
![Email Prescription and/or Health Benefit details for Highmark Blue Shield Forever Blue 770 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$201.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $25.00 | P | $14.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |