DILTIAZEM 24H ER(LA) 360 MG TABLET ER 24H [Matzim LA] (90 TABLETS ) (NDC: 68682070830)
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 Freedom Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Freedom Plus (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 | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Freedom Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Freedom Plus (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 | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Harmony (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Harmony (HMO)](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 | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Harmony (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Harmony (HMO)](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 | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Focus (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Focus (HMO)](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 | $280.80 |
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 |
AARP Medicare Advantage SecureHorizons Focus (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Focus (HMO)](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 | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $30.00 | None | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $30.00 | None | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Plus Plan (HMO)](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 | $99.00 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Plus Plan (HMO)](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 | $99.00 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $90.90 |
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 Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $90.90 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $99.90 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $99.90 |
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 |
2 |
Generic |
$15.00 | $45.00 | None | $340.20 |
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 | $340.20 |
Browse Plan Formulary |
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) |
$0.00 |
$480 |
No |
2 |
Generic |
$15.00 | $45.00 | None | $340.20 |
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) |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | None | $340.20 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $234.90 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
Few Generics |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $234.90 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue 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 |
$95.00 | $285.00 | None | $234.00 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue 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 |
$95.00 | $285.00 | None | $234.00 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (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 | $190.00 | None | $234.00 |
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 |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (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 | $190.00 | None | $234.00 |
Browse Plan Formulary |
AVA (HMO)
![Email Prescription and/or Health Benefit details for AVA (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
AVA (HMO)
![Email Prescription and/or Health Benefit details for AVA (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
AVA (PPO)
![Email Prescription and/or Health Benefit details for AVA (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $7.50 | None | $235.80 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $7.50 | None | $235.80 |
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 |
Blue Shield 65 Plus Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $15.00 | None | $256.50 |
Browse Plan Formulary |
Blue Shield 65 Plus Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $15.00 | None | $256.50 |
Browse Plan Formulary |
Blue Shield AdvantageOptimum Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield AdvantageOptimum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $7.50 | None | $235.80 |
Browse Plan Formulary |
Blue Shield AdvantageOptimum Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield AdvantageOptimum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $7.50 | None | $235.80 |
Browse Plan Formulary |
Blue Shield Balance (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Balance (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $4.50 | None | $233.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Blue Shield Balance (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Balance (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $4.50 | None | $233.10 |
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 |
Blue Shield Inspire (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Inspire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $4.50 | None | $235.80 |
Browse Plan Formulary |
Blue Shield Inspire (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Inspire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $4.50 | None | $235.80 |
Browse Plan Formulary |
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | None | $233.10 |
Browse Plan Formulary |
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
2 |
Tier 2 |
0% | 0% | None | $233.10 |
Browse Plan Formulary |
Blue Shield TotalDual Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Blue Shield TotalDual Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | 25% | None | $124.20 |
Browse Plan Formulary |
CalPlus (HMO)
![Email Prescription and/or Health Benefit details for CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No |
3 |
Preferred Brand |
25% | 25% | None | $289.80 |
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 |
CalPlus (HMO)
![Email Prescription and/or Health Benefit details for CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | None | $289.80 |
Browse Plan Formulary |
ESRD Balance (HMO C-SNP)
![Email Prescription and/or Health Benefit details for ESRD Balance (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
ESRD Balance (HMO C-SNP)
![Email Prescription and/or Health Benefit details for ESRD Balance (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
1 |
Tier 1 |
0% | 0% | None | $224.10 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
1 |
Tier 1 |
0% | 0% | None | $224.10 |
Browse Plan Formulary |
Heart & Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Heart & Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
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 |
Heart & Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Heart & Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
Browse Plan Formulary |
Imperial Senior Value (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Imperial Senior Value (HMO C-SNP)](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 | $292.50 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Imperial Senior Value (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Imperial Senior Value (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Some Brands |
2 |
Generic |
$5.00 | $10.00 | None | $292.50 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](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 | $471.60 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](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 | $471.60 |
Browse Plan Formulary |
My Choice (HMO)
![Email Prescription and/or Health Benefit details for My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
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 |
My Choice (HMO)
![Email Prescription and/or Health Benefit details for My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
Browse Plan Formulary |
Platinum (HMO)
![Email Prescription and/or Health Benefit details for Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
Browse Plan Formulary |
Platinum (HMO)
![Email Prescription and/or Health Benefit details for Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
Browse Plan Formulary |
smartHMO (HMO)
![Email Prescription and/or Health Benefit details for smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
Browse Plan Formulary |
smartHMO (HMO)
![Email Prescription and/or Health Benefit details for smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $289.80 |
Browse Plan Formulary |
the ONE + Rite Aid (HMO)
![Email Prescription and/or Health Benefit details for the ONE + Rite Aid (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
the ONE + Rite Aid (HMO)
![Email Prescription and/or Health Benefit details for the ONE + Rite Aid (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
UnitedHealthcare Chronic Complete (HMO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Chronic Complete (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Generic |
$0.00 | $0.00 | None | $280.80 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
UnitedHealthcare Chronic Complete (HMO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Chronic Complete (HMO C-SNP)](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 | $280.80 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
Wellcare Dual Liberty (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Liberty (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $118.80 |
Browse Plan Formulary |
Wellcare Dual Liberty Freedom (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Liberty Freedom (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $302.40 |
Browse Plan Formulary |
Wellcare Dual Liberty Freedom (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Liberty Freedom (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $302.40 |
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 Giveback (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback (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 | None | $302.40 |
Browse Plan Formulary |
Wellcare Giveback (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback (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 | None | $302.40 |
Browse Plan Formulary |
Wellcare Giveback Focus (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Focus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | None | $302.40 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Wellcare Giveback Focus (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Focus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | None | $302.40 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Wellcare Low Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Low Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $200.70 |
Browse Plan Formulary |
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 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $204.30 |
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 |
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 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $204.30 |
Browse Plan Formulary |
Wellcare No Premium Best (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Best (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $302.40 |
Browse Plan Formulary |
Wellcare No Premium Best (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Best (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $302.40 |
Browse Plan Formulary |
Wellcare Plus (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $302.40 |
Browse Plan Formulary |
Wellcare Plus (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $302.40 |
Browse Plan Formulary |
Wellcare Specialty No Premium (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Specialty No Premium (HMO C-SNP)](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 | $209.70 |
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 |
Wellcare Specialty No Premium (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Specialty No Premium (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Generic |
$8.00 | $0.00 | None | $209.70 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$2.10 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $234.00 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$2.10 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $234.00 |
Browse Plan Formulary |
Wellcare Low Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Low Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $200.70 |
Browse Plan Formulary |
AVA (PPO)
![Email Prescription and/or Health Benefit details for AVA (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $120.00 | None | $289.80 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.70 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $126.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem MediBlue Extra (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.70 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | None | $126.90 |
Browse Plan Formulary |
Align Premier (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Align Premier (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$480 |
No |
1 |
Tier 1 |
25% | 25% | None | $340.20 |
Browse Plan Formulary |
Align Premier (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Align Premier (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $340.20 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Tier 2 |
$15.00 | $30.00 | None | $305.10 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Tier 2 |
$15.00 | $30.00 | None | $305.10 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.70 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$9.00 | $0.00 | None | $280.80 |
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 |
AARP Medicare Advantage SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.70 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$9.00 | $0.00 | None | $280.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.40 |
$480 |
No |
2 |
Tier 2 |
15% | 15% | None | $285.30 |
Browse Plan Formulary |
Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $285.30 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Assure (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Assure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.70 |
$480 |
No |
2 |
Tier 2 |
25% | 25% | None | $280.80 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Assure (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Assure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.70 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $280.80 |
Browse Plan Formulary |
Blue Shield Coordinated Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Coordinated Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | 25% | None | $133.20 |
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 |
Blue Shield Coordinated Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Coordinated Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | 25% | None | $133.20 |
Browse Plan Formulary |
Blue Shield TotalDual Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Blue Shield TotalDual Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
Few Generics |
2 |
Generic |
25% | 25% | None | $124.20 |
Browse Plan Formulary |
Wellcare Dual Liberty (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Liberty (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $118.80 |
Browse Plan Formulary |
Wellcare Plus Sapphire I (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Plus Sapphire I (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $115.20 |
Browse Plan Formulary |
Wellcare Plus Sapphire I (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Plus Sapphire I (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $115.20 |
Browse Plan Formulary |
Wellcare Plus Sapphire II (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Plus Sapphire II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
No |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $122.40 |
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 Plus Sapphire II (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Plus Sapphire II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $122.40 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.50 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $110.70 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $25.00 | None | $110.70 |
Browse Plan Formulary |