AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel] (30 CAPSULES ) (NDC: 68180047301)
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 Freedom Plus (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage SecureHorizons Plan 4 (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Plus Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $5.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $5.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Align Connect (HMO C-SNP)
|
$0.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $13.24 |
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 |
Align Thrive (HMO I-SNP)
|
$0.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $13.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health AVA (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$3.00 | $0.00 | None | $15.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health AVA (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$5.00 | $0.00 | None | $15.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health CalPlus + Veterans (HMO)
|
$0.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Select Care Drugs |
$5.00 | $0.00 | None | $15.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Harmony (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$3.00 | $0.00 | None | $15.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$5.00 | $0.00 | None | $15.32 |
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 |
Alignment Health My Choice CalPlus (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$5.00 | $0.00 | None | $15.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Platinum (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$5.00 | $0.00 | None | $14.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Select (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$3.00 | $0.00 | None | $14.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$5.00 | $0.00 | None | $15.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE + Rite Aid (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$5.00 | $0.00 | None | $15.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Select Care Drugs |
$0.00 | $0.00 | None | $6.02 |
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 |
Anthem MediBlue Prime (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Astiva Health C-SNP Savings (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $15.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Astiva Health Classic Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $15.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Astiva Health Savings Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $15.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.82 |
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 |
Blue Shield AdvantageOptimum Plan 1 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Bridges Care Plan (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Classic Care I Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Classic Care I Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Embrace Care Plan (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Embrace Care Plan (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.13 |
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 |
Brand New Day Part B Savings Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Select Care II Plan (HMO I-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Fortune Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Fortune Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Fortune Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Fortune Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.55 |
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 |
Clever Care Fortune Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Longevity Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Longevity Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Longevity Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Longevity Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Longevity Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.44 |
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 |
Clever Care Value Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Value Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Value Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Value Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clever Care Value Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-016 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $6.83 |
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 |
Humana Gold Plus H5619-150 (HMO)
|
$0.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $6.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $6.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Dynamic Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Senior Value (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Strong (HMO)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $16.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Imperial Traditional (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.31 |
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 |
Kaiser Permanente Senior Advantage San Diego (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $6.00 | None | $17.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage San Diego Value (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$3.00 | $6.00 | None | $17.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | Q:30 /30Days | $9.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care Select (HMO)
|
$0.00 |
$450 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$15.00 | $30.00 | Q:30 /30Days | $9.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Alta (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Scripps Classic offered by SCAN Health Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.40 |
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 |
Sharp Direct Advantage Gold Card (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $19.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sharp Direct Advantage VIP Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $19.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sharp SecureHorizons Plan by UnitedHealthcare (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sharp Walgreens by UnitedHealthcare (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
UC San Diego Health Humana (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $6.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Chronic Complete Focus (HMO-POS C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.16 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Select Care Drugs |
$0.00 | $0.00 | Q:30 /30Days | $3.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $6.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Preferred Plan (HMO D-SNP)
|
$14.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $8.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Extra (HMO)
|
$23.00 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Align 129 (HMO D-SNP)
|
$23.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $21.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-148 (HMO)
|
$24.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $6.83 |
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 |
AARP Medicare Advantage SecureHorizons Value (HMO-POS)
|
$25.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Scripps Heart First offered by SCAN Health Plan (HMO C-SNP)
|
$26.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Advantage Medicare Medi-Cal San Diego (HMO D-SNP)
|
$29.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $17.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue ESRD Care (PPO C-SNP)
|
$29.30 |
$130 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$6.00 | $0.00 | None | $5.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Classic Care II Plan (HMO)
|
$36.70 |
$50* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $13.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Classic Care II Plan (HMO)
|
$36.70 |
$50* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $13.13 |
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 |
SCAN Connections at Home (HMO D-SNP)
|
$37.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $6.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Align Premier (HMO I-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $13.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Astiva Health C-SNP Premium (HMO C-SNP)
|
$38.90 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $15.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Shield TotalDual Plan (HMO D-SNP)
|
$38.90 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $2.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Bridges Choice Plan (HMO C-SNP)
|
$38.90 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $13.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Embrace Choice Plan (HMO C-SNP)
|
$38.90 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $13.41 |
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 |
Brand New Day Embrace Choice Plan (HMO C-SNP)
|
$38.90 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $13.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Brand New Day Select Choice II Plan (HMO I-SNP)
|
$38.90 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $13.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage (HMO SNP) (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $7.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Plus (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Connections (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $6.73 |
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 |
Sharp Direct Advantage Platinum Card (HMO)
|
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days | $19.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage SecureHorizons Premier (HMO-POS)
|
$67.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Shield Select (PPO)
|
$67.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Scripps Signature offered by SCAN Health Plan (HMO)
|
$74.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice Plan (PPO)
|
$87.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $5.25 |
Browse Plan Formulary all covered insulin pay $35 or less |