ALISKIREN 150 MG TABLET [Tekturna] (30 tablets ) (NDC: 66993014130)
2023 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 Ally (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $124.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Choice (PPO)
|
$0.00 |
$245* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $120.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Plan 1 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $120.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Plan 2 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $118.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice Plan (PPO)
|
$0.00 |
$300* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $100.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Freedom Plan (PPO)
|
$0.00 |
$200* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $101.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$200* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $101.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$150* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $101.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Choice (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $104.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Classic (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $103.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $103.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
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 |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $103.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $104.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $105.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $102.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Classic Plus (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $102.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage ESRD Care Plus (HMO C-SNP)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $103.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Amerivantage Select Plus (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 6 |
Select Care Drugs |
$0.00 | $0.00 | None | $104.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Basic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $165.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Choice Plus (PPO)
|
$0.00 |
$505* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $166.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Classic (PPO)
|
$0.00 |
$200 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$85.00 | $255.00 | Q:30 /30Days | $168.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Dental Premier (PPO)
|
$0.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$85.00 | $255.00 | Q:30 /30Days | $167.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Health Choice (PPO)
|
$0.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$85.00 | $255.00 | Q:30 /30Days | $167.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Alliance Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Savings Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Greater Houston (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $145.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted GIVEBACK Greater Houston (HMO)
|
$0.00 |
$300* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$7.00 | $17.50 | None | $145.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-042 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days | $152.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-043 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:30 /30Days | $153.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-043 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:30 /30Days | $151.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-043 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:30 /30Days | $153.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Insurance Company Traditional (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $69.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Insurance Traditional Plus (HMO)
|
$0.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $69.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Insurance Value (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $69.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
KelseyCare Advantage Gold (HMO)
|
$0.00 |
$100* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$0.00 | $0.00 | None | $100.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
KelseyCare Advantage Gold Freedom (HMO-POS)
|
$0.00 |
$100* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$0.00 | $0.00 | None | $100.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
KelseyCare Advantage Platinum (HMO)
|
$0.00 |
$100* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$0.00 | $0.00 | None | $100.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Memorial Hermann Advantage (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | $10.00 | None | $229.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$12.00 | $24.00 | None | $137.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care Select (HMO)
|
$0.00 |
$200 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$20.00 | $40.00 | None | $137.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Texas LoneStar Gold (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | None | $175.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Chronic Complete Ally (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $124.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$90.00 | $180.00 | None | $156.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$0.00 | $0.00 | None | $133.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$200* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$3.00 | $0.00 | None | $133.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Rx Plus Open (PPO)
|
$0.00 |
$300 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
48% | 48% | None | $153.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $130.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 TexanPlus Classic No Premium (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $131.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare TexanPlus No Premium (HMO-POS)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$0.00 | $0.00 | None | $131.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$7.40 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $193.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$7.40 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$7.40 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$7.40 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
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)
|
$7.40 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $193.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
|
$8.90 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $132.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$11.90 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
44% | 44% | None | $165.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$17.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $103.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$17.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $103.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$17.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $104.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$17.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $105.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$17.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $102.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Coordination Plus (HMO D-SNP)
|
$17.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $102.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$17.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $193.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice II Plan (PPO)
|
$18.00 |
$300* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $100.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Coordination (HMO D-SNP)
|
$18.70 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $103.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Complete Plan (HMO D-SNP)
|
$19.80 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $127.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$21.20 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $164.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
|
$22.80 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $164.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$23.20 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $164.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$24.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $103.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$24.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $103.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$24.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $104.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$24.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $105.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$24.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $102.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Amerivantage Dual Secure Plus (HMO D-SNP)
|
$24.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 6 |
Select Care Drugs |
$10.00 | $30.00 | None | $102.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Health Choice (HMO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $225.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Health Choice (HMO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $229.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Community Health Choice (HMO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $225.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME Greater Houston (HMO)
|
$25.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $145.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $152.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $152.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Insurance Company Dual (HMO D-SNP)
|
$25.00 |
$505 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
25% | 25% | Q:30 /30Days | $67.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Memorial Hermann Advantage Plus (HMO)
|
$25.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | $10.00 | None | $229.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Memorial Hermann Dual Advantage (HMO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$0.00 | $0.00 | None | $229.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$25.00 |
$505 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
33% | 33% | None | $137.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
ProCare Advantage (HMO-POS I-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $235.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Texas Independence Health Plan, Inc. (HMO I-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $136.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $115.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $125.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 (HMO-POS D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $127.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Ally (HMO-POS D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $124.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $132.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $124.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $122.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $163.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Gold (Regional PPO C-SNP)
|
$27.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $132.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R4182-004 (Regional PPO)
|
$41.00 |
$175 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:30 /30Days | $152.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Advantage Choice (Regional PPO)
|
$49.00 |
$395* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $132.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-084 (PFFS)
|
$70.00 |
$250 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:30 /30Days | $152.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R4182-003 (Regional PPO)
|
$84.00 |
$175 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:30 /30Days | $152.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Choice Premier (PPO)
|
$88.00 |
$295* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $166.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-042 (PPO)
|
$93.00 |
$200 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:30 /30Days | $152.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Flex (PPO)
|
$213.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$85.00 | $255.00 | Q:30 /30Days | $167.43 |
Browse Plan Formulary all covered insulin pay $35 or less |