AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak] (6 tablets ) (NDC: 50111078710)
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 Choice Rebate (PPO)
|
$0.00 |
$395* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom Plan (PPO)
|
$0.00 |
$150* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom Plus Plan (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Access Basic (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$4.00 | $0.00 | None | $4.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$4.00 | $0.00 | None | $4.96 |
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 GA Medicare (HMO)
|
$0.00 |
$280* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $0.00 | None | $7.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred GA Medicare (HMO)
|
$0.00 |
$280* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$3.00 | $0.00 | None | $7.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $7.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $7.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Choice Plan (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Select Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.99 |
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 |
Clear Spring Health Silver Plan (HMO C-SNP)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H4141-017 (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $6.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H4141-017 (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $6.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$145* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$0.00 | $0.00 | None | $6.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-154 (PPO)
|
$0.00 |
$400* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$15.00 | $0.00 | None | $6.66 |
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 H5216-203 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $6.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-203 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-279 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $6.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-345 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $6.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R3392-004 (Regional PPO)
|
$0.00 |
$195* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$12.00 | $0.00 | None | $6.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Chronic Complete (PPO C-SNP)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $1.85 |
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 Advantage Choice Plan 1 (PPO)
|
$0.00 |
$275* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$480* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.22 |
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. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $1.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$75* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$9.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$12.00 | $0.00 | None | $6.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$9.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$12.00 | $0.00 | None | $6.72 |
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 Silver (Regional PPO C-SNP)
|
$9.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $1.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
|
$15.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $1.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Enhanced Care (HMO D-SNP)
|
$17.20 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $15.00 | None | $4.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Extra (HMO)
|
$24.50 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $15.00 | None | $4.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$25.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $7.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$26.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $7.39 |
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)
|
$26.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $7.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (PPO)
|
$28.00 |
$505* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$28.10 |
$475* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $2.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Preferred Premium Plan (PPO)
|
$32.00 |
$150* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $6.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP)
|
$32.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $1.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$34.80 |
$505 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$12.00 | $0.00 | None | $6.61 |
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)
|
$35.90 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $1.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $3.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-280 (PPO)
|
$36.70 |
$505 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$20.00 | $0.00 | None | $6.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-280 (PPO)
|
$36.70 |
$505 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$20.00 | $0.00 | None | $6.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.20 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $3.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Dual Access (PPO D-SNP)
|
$37.30 |
$440 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$10.00 | $30.00 | None | $4.97 |
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 |
Anthem MediBlue Dual Advantage (HMO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$10.00 | $30.00 | None | $4.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareSource Dual Advantage (HMO D-SNP)
|
$37.30 |
$505 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
25% | 25% | None | $1.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Deluxe Plan (HMO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $5.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$37.30 |
$395* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Georgia Health Advantage (HMO I-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $5.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Georgia Health Advantage Choice (HMO I-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $5.19 |
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 SNP-DE H4141-003 (HMO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$0.00 | $0.00 | None | $6.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$0.00 | $0.00 | None | $6.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-206 (PPO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $6.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
PruittHealth Premier D-SNP (HMO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | None | $5.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice LP (PPO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $1.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$37.30 |
$505 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $3.84 |
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 Essential (HMO)
|
$38.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$5.00 | $0.00 | None | $4.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Advantage Choice (Regional PPO)
|
$49.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$55.00 |
$150* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Access (PPO)
|
$59.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$4.00 | $0.00 | None | $4.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Enhanced Open (PPO)
|
$85.00 |
$75* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $1.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R3392-002 (Regional PPO)
|
$103.00 |
$340* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$17.00 | $0.00 | None | $6.66 |
Browse Plan Formulary all covered insulin pay $35 or less |