BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone] (30 tablets ) (NDC: 00054018813)
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 Mosaic Choice (PPO)
|
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $16.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Prime (HMO-POS)
|
$0.00 |
$295* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $16.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $17.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:90 /30Days | $15.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeWell New York LiveWell (HMO)
|
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $22.50 | None | $58.04 |
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 |
Centers Plan for Medicare Advantage Care (HMO)
|
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $37.50 | Q:90 /30Days | $50.62 |
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. |
2 |
Generic |
$5.00 | $0.00 | Q:360 /30Days | $52.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan Flex (HMO)
|
$0.00 |
$375* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | Q:90 /30Days | $32.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Reserve Classic (HMO)
|
$0.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | Q:360 /30Days | $81.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue HealthPlus (HMO)
|
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | Q:360 /30Days | $65.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue HealthPlus Select (HMO)
|
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | Q:360 /30Days | $64.61 |
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 |
Empire MediBlue Select (HMO)
|
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $65.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst 65 Plus Plan (HMO)
|
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $10.00 | Q:90 /30Days | $78.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst Signature (HMO)
|
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $10.00 | Q:90 /30Days | $78.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst Signature (PPO)
|
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $10.00 | Q:90 /30Days | $78.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | Q:90 /30Days | $28.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$7.00 | $0.00 | Q:90 /30Days | $11.73 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $0.00 | Q:90 /30Days | $12.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | Q:90 /30Days | $11.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$8.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $13.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Plus (HMO)
|
$16.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $57.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Plus (HMO)
|
$16.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $71.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Plus (HMO)
|
$16.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $59.29 |
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 (Regional PPO)
|
$16.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $16.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $0.00 | Q:90 /30Days | $15.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$16.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $17.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Fidelis Dual Plus (HMO D-SNP)
|
$21.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $17.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan 3 (PPO)
|
$23.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:90 /30Days | $15.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Fidelis Dual Access (HMO D-SNP)
|
$24.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $17.63 |
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 |
VNS Health EasyCare (HMO)
|
$25.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:90 /30Days | $28.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst CompleteCare (HMO D-SNP)
|
$26.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:90 /30Days | $78.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst Increased Benefits Plan (HMO)
|
$29.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:90 /30Days | $78.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$30.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:90 /30Days | $15.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst Life Improvement Plan (HMO D-SNP)
|
$32.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:90 /30Days | $78.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Plan 2 (HMO-POS)
|
$34.00 |
$295* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $18.48 |
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 Plan 2 (HMO-POS D-SNP)
|
$34.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $17.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)
|
$34.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $16.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
|
$35.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:90 /30Days | $18.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
|
$35.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $17.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO D-SNP)
|
$36.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $41.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan Assist (HMO I-SNP)
|
$38.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$14.00 | $28.00 | Q:90 /30Days | $32.42 |
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 |
RiverSpring MAP (HMO D-SNP)
|
$38.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:360 /30Days | $98.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
RiverSpring Star (HMO I-SNP)
|
$38.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:360 /30Days | $98.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeWell New York Advantage Plus (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $58.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeWell New York CareWell (HMO I-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $64.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeWell New York FeelWell (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $58.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
ArchCare Advantage (HMO I-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:90 /30Days | $101.36 |
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 |
Centers Plan for Dual Coverage Care (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $52.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Centers Plan for Medicaid Advantage Plus (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $48.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Centers Plan for Nursing Home Care (HMO I-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:90 /30Days | $48.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:90 /30Days | $32.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan Extra Help (HMO)
|
$38.90 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | Q:90 /30Days | $32.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan For Medicaid Beneficiaries (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $32.35 |
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 |
Elderplan Plus Long Term Care (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $32.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Dual (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $83.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Dual (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $81.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Dual (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $81.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Dual Reserve (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $81.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Dual Advantage (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:360 /30Days | $67.15 |
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 |
Empire MediBlue Dual Advantage Select (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:360 /30Days | $66.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Extra Select (HMO)
|
$38.90 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $65.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $67.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)
|
$38.90 |
$450 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:360 /30Days | $67.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Hamaspik Medicare Choice (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:360 /30Days | $38.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Hamaspik Medicare Select (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:360 /30Days | $39.53 |
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 |
Longevity Health Plan (HMO I-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:360 /30Days | $82.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
MetroPlus Advantage Plan (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $69.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
MetroPlus UltraCare (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $69.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Whole Health of New York NHC (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $99.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $18.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $16.94 |
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 Plan 1 (HMO-POS D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $17.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $16.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:90 /30Days | $17.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
VillageCareMAX Medicare Health Advantage (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $28.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
VillageCareMAX Medicare Health Advantage FLEX (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $28.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
VNS Health EasyCare Plus (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $28.64 |
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 |
VNS Health Total (HMO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:90 /30Days | $28.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $17.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)
|
$44.00 |
$100* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$14.00 | $0.00 | Q:90 /30Days | $16.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Plan 1 (HMO-POS)
|
$52.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $18.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
|
$82.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $16.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold (HMO)
|
$93.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | Q:360 /30Days | $81.90 |
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 |
EmblemHealth VIP Gold (HMO)
|
$93.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | Q:360 /30Days | $81.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold (HMO)
|
$93.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | Q:360 /30Days | $83.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold (HMO)
|
$93.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | Q:360 /30Days | $81.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$97.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:90 /30Days | $20.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Ultra Open (PPO)
|
$115.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$5.00 | $0.00 | Q:90 /30Days | $11.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
VillageCareMAX Medicare Total Advantage (HMO D-SNP)
|
$125.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:90 /30Days | $28.64 |
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 |
MetroPlus Platinum Plan (HMO)
|
$142.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:90 /30Days | $69.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold Plus (HMO)
|
$254.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | Q:360 /30Days | $82.26 |
Browse Plan Formulary all covered insulin pay $35 or less |