DULOXETINE HCL DR 40 MG CAPSULE [Irenka] (30 units ) (NDC: 68180029706)
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 |
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:180 /90Days | $82.20 |
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:180 /90Days | $81.90 |
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:180 /90Days | $88.50 |
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:180 /90Days | $87.60 |
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:180 /90Days | $86.70 |
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 |
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 | Q:90 /30Days | $105.00 |
Browse Plan Formulary select insulin pay $25 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. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $65.40 |
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. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $68.10 |
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. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $67.50 |
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. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $69.30 |
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. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $71.10 |
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 |
MeridianComplete (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for MeridianComplete (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% | Q:60 /30Days | $117.00 |
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 | Q:30 /30Days | $112.50 |
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 | Q:30 /30Days | $113.70 |
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 | Q:30 /30Days | $114.30 |
Browse Plan Formulary |
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 | Q:30 /30Days | $112.50 |
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 | Q:30 /30Days | $113.10 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | Q:30 /30Days | $111.90 |
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 | Q:30 /30Days | $113.70 |
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 | Q:30 /30Days | $114.30 |
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 | Q:30 /30Days | $112.50 |
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 | Q:30 /30Days | $113.70 |
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 | Q:30 /30Days | $114.30 |
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 |
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 | Q:30 /30Days | $112.50 |
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 | Q:30 /30Days | $113.10 |
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 | Q:30 /30Days | $111.90 |
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 | Q:30 /30Days | $113.70 |
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 | Q:30 /30Days | $114.30 |
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 | Q:30 /30Days | $110.10 |
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 |
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) |
$35.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $112.50 |
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) |
$35.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $113.10 |
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) |
$35.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $111.90 |
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) |
$35.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $113.70 |
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) |
$35.00 |
$75* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $114.30 |
Browse Plan Formulary select insulin pay $15-$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) |
$70.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $65.40 |
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 |
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) |
$70.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $68.10 |
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) |
$70.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $67.50 |
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) |
$70.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $69.30 |
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) |
$70.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$11.00 | $0.00 | Q:180 /90Days | $71.10 |
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) |
$76.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $113.70 |
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) |
$76.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $114.30 |
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 |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $112.50 |
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) |
$76.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $113.10 |
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) |
$76.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $111.90 |
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) |
$85.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days | $112.50 |
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) |
$85.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days | $113.10 |
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) |
$85.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days | $111.90 |
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 |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days | $113.70 |
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) |
$85.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $0.00 | Q:30 /30Days | $114.30 |
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) |
$112.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $82.20 |
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) |
$112.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $81.90 |
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) |
$112.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $88.50 |
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) |
$112.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $87.60 |
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 |
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) |
$112.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $86.70 |
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) |
$147.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | Q:180 /90Days | $65.40 |
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) |
$147.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | Q:180 /90Days | $68.10 |
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) |
$147.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | Q:180 /90Days | $67.50 |
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) |
$147.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | Q:180 /90Days | $69.30 |
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) |
$147.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | Q:180 /90Days | $71.10 |
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 |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$149.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:30 /30Days | $114.30 |
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) |
$149.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:30 /30Days | $112.50 |
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) |
$149.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:30 /30Days | $113.10 |
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) |
$149.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:30 /30Days | $111.90 |
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) |
$149.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:30 /30Days | $113.70 |
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) |
$245.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $82.20 |
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) |
$245.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $81.90 |
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) |
$245.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $88.50 |
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) |
$245.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $87.60 |
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) |
$245.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $86.70 |
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) |
$258.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $68.10 |
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) |
$258.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $67.50 |
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 |
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) |
$258.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $69.30 |
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) |
$258.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $71.10 |
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) |
$258.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:180 /90Days | $65.40 |
Browse Plan Formulary |