Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL (5 VIAL, SINGLE-DOSE ) (NDC: 49281058905)
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 Plus Plan 1 (HMO-POS)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:1 /1Days | $298.56 |
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. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $305.80 |
Browse Plan Formulary |
Aetna Medicare Essential Plan (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $305.80 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (PPO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $305.80 |
Browse Plan Formulary |
Anthem MediBlue + Kroger (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $300.91 |
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. |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $300.91 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $302.21 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $302.11 |
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 | $154.85 |
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 | $154.96 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $154.98 |
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 True Choice Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $154.98 |
Browse Plan Formulary |
Clear Spring Health Choice Plan (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $105.00 | None | $149.40 |
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 |
3 |
Preferred Brand |
$42.00 | $105.00 | None | $149.40 |
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 |
3 |
Preferred Brand |
$42.00 | $105.00 | None | $149.40 |
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 |
3 |
Preferred Brand |
$37.00 | $110.00 | None | $300.53 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H4141-017 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $301.63 |
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 H4141-017 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.20 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H4141-017 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.14 |
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 |
3* |
Preferred Brand |
$47.00 | $131.00 | None | $303.41 |
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 |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.77 |
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 |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $301.63 |
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 |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.33 |
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 |
Kaiser Permanente Senior Advantage Basic 2 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Vaccines |
$0.00 | n/a | None | $290.16 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:1 /1Days | $300.26 |
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. |
6 |
Select Care Drugs |
$0.00 | $0.00 | None | $296.54 |
Browse Plan Formulary |
Wellcare Giveback (HMO)
|
$0.00 |
$400* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.54 |
Browse Plan Formulary |
Wellcare No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
6 |
Select Care Drugs |
$0.00 | $0.00 | None | $295.28 |
Browse Plan Formulary |
Wellcare No Premium Medicare (HMO)
|
$0.00 |
$280* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $299.07 |
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 Open (PPO)
|
$0.00 |
$75* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.54 |
Browse Plan Formulary |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
|
$9.20 |
$480 |
No |
3 |
Tier 3 |
25% | 25% | Q:1 /1Days | $301.39 |
Browse Plan Formulary |
UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
|
$17.20 |
$210* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:1 /1Days | $301.39 |
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 |
3 |
Preferred Brand |
$42.00 | $105.00 | None | $149.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Kaiser Permanente Senior Advantage Enhanced 2 (HMO)
|
$20.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Vaccines |
$0.00 | n/a | None | $290.16 |
Browse Plan Formulary |
Aetna Medicare Dual Preferred Plan (HMO D-SNP)
|
$21.80 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $305.80 |
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 |
Humana Together in Health (PPO I-SNP)
|
$23.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.35 |
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 |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.22 |
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 | $154.93 |
Browse Plan Formulary |
HumanaChoice SNP-DE H5216-206 (PPO D-SNP)
|
$25.80 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.25 |
Browse Plan Formulary |
HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
|
$28.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.25 |
Browse Plan Formulary |
Senior Advantage Medicare Medicaid Plan 2 (HMO D-SNP)
|
$28.90 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Vaccines |
$0.00 | n/a | None | $290.16 |
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 TotalCare (HMO D-SNP)
|
$30.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $158.33 |
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 | $158.33 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$30.50 |
$480 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $302.11 |
Browse Plan Formulary |
Anthem MediBlue + Kroger Dual Advantage (HMO D-SNP)
|
$32.40 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $300.91 |
Browse Plan Formulary |
Anthem MediBlue Dual Access (PPO D-SNP)
|
$32.40 |
$380 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $302.21 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO D-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $302.11 |
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 |
CareSource Dual Advantage (HMO D-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | None | $135.76 |
Browse Plan Formulary |
Clear Spring Health Deluxe Plan (HMO D-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $134.69 |
Browse Plan Formulary |
Clover Health LiveHealthy Value (PPO)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $300.53 |
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 | $287.63 |
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 | $287.63 |
Browse Plan Formulary |
HumanaChoice H5216-280 (PPO)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $304.54 |
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 |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.41 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:1 /1Days | $300.88 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice LP (PPO D-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:1 /1Days | $300.91 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:1 /1Days | $300.91 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:1 /1Days | $302.00 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$32.40 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:1 /1Days | $302.00 |
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 |
Wellcare Assist (HMO)
|
$32.40 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.83 |
Browse Plan Formulary |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.83 |
Browse Plan Formulary |
Wellcare Dual Access Medicare (HMO D-SNP)
|
$32.40 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $295.56 |
Browse Plan Formulary |
Wellcare Dual Access Open (PPO D-SNP)
|
$32.40 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.83 |
Browse Plan Formulary |
Wellcare Dual Liberty (HMO D-SNP)
|
$32.40 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.83 |
Browse Plan Formulary |
Anthem MediBlue Essential (HMO)
|
$38.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $305.48 |
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 |
Humana Gold Choice H8145-069 (PFFS)
|
$44.00 |
$340 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.82 |
Browse Plan Formulary |
HumanaChoice H5216-073 (PPO)
|
$44.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.14 |
Browse Plan Formulary |
AARP Medicare Advantage Plus Plan 2 (HMO-POS)
|
$49.00 |
$175* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:1 /1Days | $298.56 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Advantra Preferred Plan (PPO)
|
$49.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $305.80 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Choice (Regional PPO)
|
$49.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:1 /1Days | $301.39 |
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. |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.54 |
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 R3392-002 (Regional PPO)
|
$55.80 |
$340 |
No |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $303.77 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$59.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $302.21 |
Browse Plan Formulary |
Wellcare Premium Enhanced Open (PPO)
|
$85.00 |
$75* |
Yes, but No Gap Coverage for this drug. |
6* |
Select Care Drugs |
$0.00 | $0.00 | None | $296.54 |
Browse Plan Formulary |