PALIPERIDONE ER 3 MG TABLET ER 24 [Invega] (30 UNITS ) (NDC: 10147095203)
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:30 /30Days | $286.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Anthem MediBlue + Kroger (HMO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days | $264.30 |
Browse Plan Formulary |
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:30 /30Days | $264.30 |
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:30 /30Days | $259.20 |
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:30 /30Days | $261.00 |
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 |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:60 /30Days | $334.50 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:60 /30Days | $334.50 |
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:30 /30Days | $347.40 |
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 | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:30 /30Days | $347.40 |
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 | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:30 /30Days | $347.40 |
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 | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:30 /30Days | $297.30 |
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 Care Extra (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $291.90 |
Browse Plan Formulary |
Humana Gold Plus H4141-017 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $291.60 |
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 | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $291.90 |
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 | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $290.40 |
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:30 /30Days | $291.90 |
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:30 /30Days | $291.90 |
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 |
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:30 /30Days | $291.90 |
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:30 /30Days | $289.50 |
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 | $740.40 |
Browse Plan Formulary |
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:30 /30Days | $268.80 |
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 | Q:30 /30Days | $217.80 |
Browse Plan Formulary |
Wellcare Giveback (HMO)
|
$0.00 |
$400* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $217.80 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $216.90 |
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 | Q:30 /30Days | $217.80 |
Browse Plan Formulary |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
|
$9.20 |
$480 | No | 4 |
Tier 4 |
25% | 25% | Q:30 /30Days | $263.70 |
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:30 /30Days | $263.70 |
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:30 /30Days | $347.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Cigna Preferred GA Medicare (HMO)
|
$20.00 |
$280 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
37% | 37% | P Q:60 /30Days | $324.00 |
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 |
Cigna Preferred GA Medicare (HMO)
|
$20.00 |
$280 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
37% | 37% | P Q:60 /30Days | $332.70 |
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:30 /30Days | $291.60 |
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:30 /30Days | $291.60 |
Browse Plan Formulary |
Humana Care Extra (PPO D-SNP)
|
$24.20 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $291.90 |
Browse Plan Formulary |
Cigna Preferred Plus Medicare (HMO)
|
$25.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:60 /30Days | $330.60 |
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:30 /30Days | $291.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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:30 /30Days | $291.60 |
Browse Plan Formulary |
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 | $740.40 |
Browse Plan Formulary |
Cigna TotalCare (HMO D-SNP)
|
$30.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | P Q:60 /30Days | $331.20 |
Browse Plan Formulary |
Cigna TotalCare Plus (HMO D-SNP)
|
$30.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | P Q:60 /30Days | $331.20 |
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:30 /30Days | $261.00 |
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:30 /30Days | $264.30 |
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 |
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:30 /30Days | $259.20 |
Browse Plan Formulary |
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:30 /30Days | $261.00 |
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:30 /30Days | $263.10 |
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:30 /30Days | $287.70 |
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% | Q:30 /30Days | $297.30 |
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 | $487.20 |
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 |
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 | $487.20 |
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:30 /30Days | $292.50 |
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:30 /30Days | $291.90 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
|
$32.40 |
$200 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $266.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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:30 /30Days | $275.40 |
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:30 /30Days | $272.10 |
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 |
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:30 /30Days | $272.10 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:30 /30Days | $252.00 |
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:30 /30Days | $269.10 |
Browse Plan Formulary |
Wellcare Assist (HMO)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
42% | 42% | Q:30 /30Days | $288.30 |
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% | Q:30 /30Days | $288.30 |
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% | Q:30 /30Days | $288.30 |
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 Dual Liberty (HMO D-SNP)
|
$32.40 |
$480 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | Q:30 /30Days | $288.30 |
Browse Plan Formulary |
Aetna Medicare Freedom Plan (PPO)
|
$35.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $119.70 |
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:30 /30Days | $291.60 |
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:30 /30Days | $263.70 |
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 | Q:30 /30Days | $217.80 |
Browse Plan Formulary |
HumanaChoice R3392-002 (Regional PPO)
|
$55.80 |
$340 | No | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $291.90 |
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 Access (PPO)
|
$59.00 |
$95 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days | $259.20 |
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 | $740.40 |
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 | Q:30 /30Days | $217.80 |
Browse Plan Formulary |