AMETHIA 0.15-0.03-0.01 MG TABLET (91 EA ) (NDC: 51862004791)
2022 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 Open Plan 1 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Open Plan 1 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $46.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $59.40 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $10.00 | None | $29.70 |
Browse Plan Formulary |
Align Connect (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Align Connect (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | None | $83.70 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$11.00 | $0.00 | Q:91 /91Days | $82.80 |
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 |
BCN Advantage HMO-POS Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$11.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$11.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$11.00 | $0.00 | Q:91 /91Days | $46.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prime Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prime Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$50* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$11.00 | $0.00 | Q:91 /91Days | $59.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HAP Primary Choice Medicare (HMO)
![Email Prescription and/or Health Benefit details for HAP Primary Choice Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $102.60 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
HAP Senior Plus (HMO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $101.70 |
Browse Plan Formulary select insulin pay $25 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 |
HAP Senior Plus Option 1 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 1 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $101.70 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
Humana Gold Plus H8908-004 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8908-004 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $39.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H8087-004 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H8087-004 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $39.60 |
Browse Plan Formulary |
McLaren Medicare Inspire (HMO)
![Email Prescription and/or Health Benefit details for McLaren Medicare Inspire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$3.50 | $7.88 | Q:91 /84Days | $62.10 |
Browse Plan Formulary select insulin pay $10-$35 copay but not this drug |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](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 |
50% | 50% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](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 |
50% | 50% | Q:91 /91Days | $26.10 |
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 |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](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 |
50% | 50% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](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 |
50% | 50% | Q:91 /91Days | $79.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](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 |
50% | 50% | Q:91 /91Days | $54.90 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Edge (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $113.40 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Edge (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Edge (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $115.20 |
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 |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](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 | None | $113.40 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](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 | None | $115.20 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](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 | None | $115.20 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](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 | None | $115.20 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](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 | None | $115.20 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
PriorityMedicare Vital (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Vital (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 |
$10.00 | $0.00 | None | $113.40 |
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 |
PriorityMedicare Vital (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Vital (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 |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Vital (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Vital (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 |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.20 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $39.60 |
Browse Plan Formulary |
BCN Advantage HMO-POS Community Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Community Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Community Value (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Community Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:91 /91Days | $39.60 |
Browse Plan Formulary |
HumanaChoice H8087-001 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H8087-001 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $39.60 |
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 |
Aetna Medicare Assure Premier (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Premier (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$425 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$5.00 | $15.00 | None | $29.70 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $113.40 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $115.20 |
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 |
Align Thrive (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Align Thrive (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.80 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | None | $83.70 |
Browse Plan Formulary |
McLaren Medicare Inspire Plus (HMO)
![Email Prescription and/or Health Benefit details for McLaren Medicare Inspire Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$3.50 | $7.88 | Q:91 /84Days | $62.10 |
Browse Plan Formulary select insulin pay $10-$35 copay but not this drug |
AARP Medicare Advantage Open Plan 2 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Open Plan 2 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $46.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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) |
$29.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $59.40 |
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) |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $36.00 |
Browse Plan Formulary |
McLaren Medicare Inspire Duals (HMO D-SNP)
![Email Prescription and/or Health Benefit details for McLaren Medicare Inspire Duals (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:91 /84Days | $62.10 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $83.70 |
Browse Plan Formulary |
Molina Medicare Complete Care Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $83.70 |
Browse Plan Formulary |
PriorityMedicare D-SNP (HMO D-SNP)
![Email Prescription and/or Health Benefit details for PriorityMedicare D-SNP (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$13.00 | $39.00 | None | $108.90 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $42.30 |
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) |
$31.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $42.30 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R3887-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$480 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $39.60 |
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 |
Humana Gold Plus H8908-001 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8908-001 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:91 /90Days | $39.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
McLaren Medicare Inspire Flex (HMO-POS)
![Email Prescription and/or Health Benefit details for McLaren Medicare Inspire Flex (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$3.50 | $7.88 | Q:91 /84Days | $62.10 |
Browse Plan Formulary select insulin pay $10-$35 copay but not this drug |
McLaren Medicare Inspire Flex (HMO-POS)
![Email Prescription and/or Health Benefit details for McLaren Medicare Inspire Flex (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$3.50 | $7.88 | Q:91 /84Days | $62.10 |
Browse Plan Formulary select insulin pay $10-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $113.40 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $115.20 |
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 |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
BCN Advantage HMO ConnectedCare (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO ConnectedCare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HAP Senior Plus Option 2 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 2 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$65.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $101.70 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
Paramount Elite Enhanced (HMO)
![Email Prescription and/or Health Benefit details for Paramount Elite Enhanced (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $30.00 | None | $198.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:91 /91Days | $26.10 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:91 /91Days | $79.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:91 /91Days | $54.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 1 (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 |
$10.00 | $0.00 | None | $101.70 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | None | $115.20 |
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 |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | None | $113.40 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$127.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $113.40 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$127.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $115.20 |
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 |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$127.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$127.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$127.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $46.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $59.40 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$135.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$135.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | Q:91 /91Days | $26.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$135.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$135.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | Q:91 /91Days | $79.20 |
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 |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$135.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | Q:91 /91Days | $54.90 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 3 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $101.70 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
HAP Senior Plus Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$190.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $101.70 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
HAP Senior Plus Option 4 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 4 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$200.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $101.70 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$214.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | None | $113.40 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$214.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | None | $115.20 |
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 |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$214.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$214.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$214.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | None | $115.20 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$265.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$265.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $82.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$265.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $82.80 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$265.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $46.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$265.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:91 /91Days | $59.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$300.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
45% | 45% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$300.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
45% | 45% | Q:91 /91Days | $26.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$300.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
45% | 45% | Q:91 /91Days | $11.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$300.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
45% | 45% | Q:91 /91Days | $79.20 |
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 |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$300.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
45% | 45% | Q:91 /91Days | $54.90 |
Browse Plan Formulary |