ENOXAPARIN 40 MG/0.4 ML SYRINGE [Lovenox] (12 mls ) (NDC: 00955100410)
2022 Medicare Prescription Drug Plan (MAPD) Information
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Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Additional Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage Walgreens (HMO)
|
$0.00 |
$275 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:24 /30Days | $162.84 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Choice Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $203.76 |
Browse Plan Formulary |
Aetna Medicare Essential Plan (PPO)
|
$0.00 |
$195 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $205.32 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (PPO)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $237.36 |
Browse Plan Formulary |
Anthem MediBlue + Kroger (HMO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:22 /28Days | $200.04 |
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 + Kroger Access (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:22 /28Days | $200.04 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:22 /28Days | $199.44 |
Browse Plan Formulary |
Anthem MediBlue ESRD Care (HMO C-SNP)
|
$0.00 |
$325 | Few Generics | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:22 /28Days | $202.68 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:22 /28Days | $199.32 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Cigna Preferred GA Medicare (HMO)
|
$0.00 |
$280* | No additional gap coverage, only the Donut Hole Discount | 3* |
Preferred Brand |
$42.00 | $126.00 | None | $144.12 |
Browse Plan Formulary |
Cigna Preferred GA Medicare (HMO)
|
$0.00 |
$280* | No additional gap coverage, only the Donut Hole Discount | 3* |
Preferred Brand |
$42.00 | $126.00 | None | $144.12 |
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 |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $126.00 | None | $144.12 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $126.00 | None | $144.12 |
Browse Plan Formulary |
Clear Spring Health Choice Plan (PPO)
|
$0.00 |
$250 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:11 /28Days | $269.76 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Clear Spring Health Select (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:11 /28Days | $269.76 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Clear Spring Health Silver Plan (HMO C-SNP)
|
$0.00 |
$250 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:11 /28Days | $269.76 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | None | $230.52 |
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 |
Humana Gold Plus H4141-015 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $220.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$145 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-154 (PPO)
|
$0.00 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $221.64 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-203 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.36 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-203 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $221.04 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Kaiser Permanente Senior Advantage Basic 1 (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $88.80 |
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 |
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)
|
$0.00 |
$275 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:24 /30Days | $174.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Wellcare Endurance Open (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$0.00 | $0.00 | None | $150.00 |
Browse Plan Formulary |
Wellcare Giveback (HMO)
|
$0.00 |
$400* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$5.00 | $0.00 | None | $150.00 |
Browse Plan Formulary |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | $0.00 | None | $150.12 |
Browse Plan Formulary |
Wellcare No Premium Medicare (HMO)
|
$0.00 |
$280 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $180.00 | None | $217.92 |
Browse Plan Formulary |
Wellcare No Premium Open (PPO)
|
$0.00 |
$75* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$0.00 | $0.00 | None | $150.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4141-017 (HMO)
|
$6.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.96 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H4141-017 (HMO)
|
$6.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $220.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H4141-017 (HMO)
|
$6.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
|
$9.20 |
$480 | No | 4 |
Tier 4 |
25% | 25% | Q:24 /30Days | $172.20 |
Browse Plan Formulary |
UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
|
$17.20 |
$210 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:24 /30Days | $172.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Clear Spring Health Select Plus (HMO)
|
$19.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:11 /28Days | $269.76 |
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 |
Aetna Medicare Dual Preferred Plan (HMO D-SNP)
|
$21.80 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | None | $198.72 |
Browse Plan Formulary |
Humana Together in Health (PPO I-SNP)
|
$23.00 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.36 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP)
|
$23.90 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.36 |
Browse Plan Formulary |
Cigna Preferred Plus Medicare (HMO)
|
$25.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $126.00 | None | $144.12 |
Browse Plan Formulary |
HumanaChoice SNP-DE H5216-206 (PPO D-SNP)
|
$25.80 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.48 |
Browse Plan Formulary |
HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
|
$28.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.48 |
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 |
Senior Advantage Medicare Medicaid Plan 1 (HMO D-SNP)
|
$29.00 |
$480 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$14.00 | $0.00 | None | $88.80 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
|
$30.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | None | $144.12 |
Browse Plan Formulary |
Cigna TotalCare Plus (HMO D-SNP)
|
$30.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $144.12 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$30.50 |
$480 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:22 /28Days | $199.32 |
Browse Plan Formulary |
Anthem MediBlue + Kroger Dual Advantage (HMO D-SNP)
|
$32.40 |
$400 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:22 /28Days | $200.04 |
Browse Plan Formulary |
Anthem MediBlue Dual Access (PPO D-SNP)
|
$32.40 |
$380 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:22 /28Days | $199.44 |
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 Dual Advantage (HMO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:22 /28Days | $199.32 |
Browse Plan Formulary |
CareSource Dual Advantage (HMO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:11 /28Days | $173.52 |
Browse Plan Formulary |
Clear Spring Health Deluxe Plan (HMO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:11 /28Days | $225.96 |
Browse Plan Formulary |
Clover Health LiveHealthy Value (PPO)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | None | $230.52 |
Browse Plan Formulary |
Georgia Health Advantage (HMO I-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $130.68 |
Browse Plan Formulary |
Georgia Health Advantage Choice (HMO I-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $130.68 |
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 |
HumanaChoice H5216-280 (PPO)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $219.84 |
Browse Plan Formulary |
HumanaChoice H5216-280 (PPO)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.36 |
Browse Plan Formulary |
PruittHealth Premier (HMO I-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $187.32 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:24 /30Days | $173.76 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice LP (PPO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:24 /30Days | $173.76 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:24 /30Days | $173.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:24 /30Days | $172.92 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:24 /30Days | $173.40 |
Browse Plan Formulary |
Wellcare Assist (HMO)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
42% | 42% | None | $209.88 |
Browse Plan Formulary |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
44% | 44% | None | $209.88 |
Browse Plan Formulary |
Wellcare Dual Access Medicare (HMO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $207.00 |
Browse Plan Formulary |
Wellcare Dual Access Open (PPO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
49% | 49% | None | $209.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Liberty (HMO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $209.88 |
Browse Plan Formulary |
Humana Gold Choice H8145-069 (PFFS)
|
$44.00 |
$340 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $221.04 |
Browse Plan Formulary |
HumanaChoice H5216-073 (PPO)
|
$44.00 |
$360 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $222.24 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Choice (Regional PPO)
|
$49.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:24 /30Days | $172.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Wellcare Low Premium Open (PPO)
|
$55.00 |
$150* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$0.00 | $0.00 | None | $150.00 |
Browse Plan Formulary |
HumanaChoice R3392-002 (Regional PPO)
|
$55.80 |
$340 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:11 /28Days | $221.76 |
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 Access (PPO)
|
$59.00 |
$95 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:22 /28Days | $199.44 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Enhanced 1 (HMO)
|
$71.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $88.80 |
Browse Plan Formulary |
Wellcare Premium Enhanced Open (PPO)
|
$85.00 |
$75* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$0.00 | $0.00 | None | $150.00 |
Browse Plan Formulary |