SOLTAMOX 20 MG/10 ML SOLUTION (MLS ) (NDC: 51862068201)
2022 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
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 Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
28% | n/a | None | $1,774.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Walgreens (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Walgreens (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,774.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Explorer Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Explorer Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,796.40 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
28% | n/a | None | $1,796.40 |
Browse Plan Formulary |
CCA Medicare Preferred (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$195 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $2,077.20 |
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 |
CCA One Care (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for CCA One Care (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
4 |
Tier 4 |
0% | 0% | P | $1,944.00 |
Browse Plan Formulary |
Fallon Medicare Plus Orange HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Orange HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,677.60 |
Browse Plan Formulary |
Fallon Medicare Plus Orange HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Orange HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,713.60 |
Browse Plan Formulary |
Fallon Medicare Plus Orange HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Orange HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,677.60 |
Browse Plan Formulary |
Fallon Medicare Plus Orange HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Orange HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,713.60 |
Browse Plan Formulary |
Health New England Medicare Compass (PPO)
![Email Prescription and/or Health Benefit details for Health New England Medicare Compass (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$380 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | None | $1,728.00 |
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 |
Health New England Medicare Value (HMO)
![Email Prescription and/or Health Benefit details for Health New England Medicare Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$380 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | None | $1,728.00 |
Browse Plan Formulary |
HumanaChoice H5216-138 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-138 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$275 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,846.80 |
Browse Plan Formulary |
HumanaChoice H5216-249 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-249 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,846.80 |
Browse Plan Formulary |
Medicare HMO Blue SaverRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue SaverRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,623.60 |
Browse Plan Formulary |
Medicare PPO Blue SaverRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue SaverRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | None | $1,623.60 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Saver Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Saver Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,681.20 |
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 |
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Smart Saver Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,681.20 |
Browse Plan Formulary |
UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Connected® for One Care (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 | $1,774.80 |
Browse Plan Formulary |
Wellcare Giveback Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
27% | n/a | None | $1,749.60 |
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 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $1,749.60 |
Browse Plan Formulary |
Wellcare No Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $1,749.60 |
Browse Plan Formulary |
HumanaChoice H5216-250 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-250 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,846.80 |
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 Assist Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Assist Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $1,756.80 |
Browse Plan Formulary |
UnitedHealthcare Senior Care Options (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Senior Care Options (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | None | $1,774.80 |
Browse Plan Formulary |
UnitedHealthcare Senior Care Options NHC (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Senior Care Options NHC (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | None | $1,774.80 |
Browse Plan Formulary |
AARP Medicare Advantage Choice (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Choice (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
28% | n/a | None | $1,774.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare HMO Blue ValueRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue ValueRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,623.60 |
Browse Plan Formulary |
Medicare HMO Blue ValueRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue ValueRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,623.60 |
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 |
BMC HealthNet Plan Senior Care Options (HMO D-SNP)
![Email Prescription and/or Health Benefit details for BMC HealthNet Plan Senior Care Options (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,641.60 |
Browse Plan Formulary |
CCA Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | P | $2,077.20 |
Browse Plan Formulary |
CCA Senior Care Options (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CCA Senior Care Options (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
25% | 25% | P | $1,944.00 |
Browse Plan Formulary |
NaviCare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for NaviCare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,677.60 |
Browse Plan Formulary |
Senior Whole Health (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,659.60 |
Browse Plan Formulary |
Senior Whole Health NHC (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health NHC (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,659.60 |
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 |
Tufts Health Plan Senior Care Options (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Tufts Health Plan Senior Care Options (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,659.60 |
Browse Plan Formulary |
Fallon Medicare Plus Super Saver HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Super Saver HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $1,677.60 |
Browse Plan Formulary |
Fallon Medicare Plus Super Saver HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Super Saver HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $1,713.60 |
Browse Plan Formulary |
Fallon Medicare Plus Super Saver HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Super Saver HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $1,677.60 |
Browse Plan Formulary |
Fallon Medicare Plus Super Saver HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Super Saver HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $1,713.60 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Basic Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,792.80 |
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 |
Tufts Medicare Preferred HMO Basic Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Basic Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,792.80 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Basic Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Basic Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,681.20 |
Browse Plan Formulary |
Health New England Medicare Choice (HMO)
![Email Prescription and/or Health Benefit details for Health New England Medicare Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | None | $1,728.00 |
Browse Plan Formulary |
AARP Medicare Advantage Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$225 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
29% | n/a | None | $1,774.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Wellcare Premium Enhanced Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Premium Enhanced Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $1,749.60 |
Browse Plan Formulary |
Fallon Medicare Plus Green HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Green HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,677.60 |
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 |
Fallon Medicare Plus Green HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Green HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,713.60 |
Browse Plan Formulary |
Fallon Medicare Plus Green HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Green HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,677.60 |
Browse Plan Formulary |
Fallon Medicare Plus Green HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Green HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $1,713.60 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue ValueRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,623.60 |
Browse Plan Formulary |
Medicare PPO Blue ValueRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue ValueRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,623.60 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Value Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$89.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,792.80 |
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 |
Tufts Medicare Preferred HMO Value Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Value Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$89.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,792.80 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Value Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Value Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$89.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $1,681.20 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue FlexRx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,623.60 |
Browse Plan Formulary |
Medicare HMO Blue FlexRx (HMO-POS)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue FlexRx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$96.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,623.60 |
Browse Plan Formulary |
Health New England Medicare Compass Premier (PPO)
![Email Prescription and/or Health Benefit details for Health New England Medicare Compass Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,728.00 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$109.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $1,742.40 |
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 |
Tufts Medicare Preferred HMO Prime Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$109.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $1,742.40 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$109.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $1,659.60 |
Browse Plan Formulary |
Health New England Medicare Plus (HMO)
![Email Prescription and/or Health Benefit details for Health New England Medicare Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$113.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
28% | n/a | None | $1,728.00 |
Browse Plan Formulary |
Fallon Medicare Plus Blue HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Blue HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$117.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $1,713.60 |
Browse Plan Formulary |
Fallon Medicare Plus Blue HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Blue HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$117.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $1,677.60 |
Browse Plan Formulary |
Fallon Medicare Plus Blue HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Blue HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$117.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $1,713.60 |
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 |
Fallon Medicare Plus Blue HMO (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Blue HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$117.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $1,677.60 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $60.00 | None | $1,742.40 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $60.00 | None | $1,659.60 |
Browse Plan Formulary |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $60.00 | None | $1,742.40 |
Browse Plan Formulary |
Health New England Medicare Premium (HMO)
![Email Prescription and/or Health Benefit details for Health New England Medicare Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$170.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
28% | n/a | None | $1,728.00 |
Browse Plan Formulary |
Medicare PPO Blue PlusRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue PlusRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$264.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
29% | n/a | None | $1,623.60 |
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 |
Medicare HMO Blue PlusRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue PlusRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$268.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
29% | n/a | None | $1,623.60 |
Browse Plan Formulary |