BUPROPION HCL SR 150 MG TABLET (60.000 EA ) (NDC: 00591354360)
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 |
Aetna Medicare Elite Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $11.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $10.00 | Q:60 /30Days | $16.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Centers Plan for Medicare Advantage Care (HMO)
![Email Prescription and/or Health Benefit details for Centers Plan for Medicare Advantage Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $37.50 | None | $29.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Medicare (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $57.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue HealthPlus (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue HealthPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | Q:60 /30Days | $52.19 |
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 |
Empire MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $45.00 | Q:60 /30Days | $52.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst 65 Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst 65 Plus Plan (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 | $47.00 | None | $29.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst Signature (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst Signature (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 | $47.00 | None | $29.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst Signature (PPO)
![Email Prescription and/or Health Benefit details for Healthfirst Signature (PPO)](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 | $47.00 | None | $29.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H3533-027 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-027 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$425 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $24.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5970-024 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5970-024 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $24.06 |
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 |
HumanaChoice H5970-024 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5970-024 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $24.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | None | $22.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Fidelis No Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis 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 |
2 |
Generic |
$15.00 | $0.00 | None | $46.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
$325 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $46.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $45.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $46.57 |
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 |
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) |
$8.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | None | $29.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Assist (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $43.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $68.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Fidelis Assist (HMO-POS)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis Assist (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $46.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Fidelis Dual Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis Dual Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $70.52 |
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 Elite Plan 3 (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite Plan 3 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:60 /30Days | $16.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Fidelis Dual Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Fidelis Dual Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $72.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
VNS Health EasyCare (HMO)
![Email Prescription and/or Health Benefit details for VNS Health EasyCare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $22.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst CompleteCare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Healthfirst CompleteCare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
19% | 19% | None | $30.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H3533-032 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-032 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $24.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H3533-032 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H3533-032 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $24.21 |
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 |
Healthfirst Increased Benefits Plan (HMO)
![Email Prescription and/or Health Benefit details for Healthfirst Increased Benefits Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $30.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Healthfirst Life Improvement Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Healthfirst Life Improvement Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
16% | 16% | None | $30.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Plan 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Plan 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$295* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | None | $34.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $30.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $29.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $31.97 |
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 |
Aetna Medicare Assure Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $24.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan Assist (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Elderplan Assist (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
3* |
Preferred Brand |
$47.00 | $94.00 | None | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
RiverSpring MAP (HMO D-SNP)
![Email Prescription and/or Health Benefit details for RiverSpring MAP (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $37.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
RiverSpring Star (HMO I-SNP)
![Email Prescription and/or Health Benefit details for RiverSpring Star (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $37.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
ArchCare Advantage (HMO I-SNP)
![Email Prescription and/or Health Benefit details for ArchCare Advantage (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $40.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Centers Plan for Dual Coverage Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Dual Coverage Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $28.44 |
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 |
Centers Plan for Medicaid Advantage Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Medicaid Advantage Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $29.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Centers Plan for Nursing Home Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Centers Plan for Nursing Home Care (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $29.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan Advantage For Nursing Home Residents (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Elderplan Advantage For Nursing Home Residents (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Elderplan Plus Long Term Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Elderplan Plus Long Term Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $12.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | None | $26.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | None | $24.10 |
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 Dual (HMO D-SNP)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Dual (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | None | $23.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:60 /30Days | $52.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Dual Advantage Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue Dual Advantage Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | Q:60 /30Days | $52.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue Extra Select (HMO)
![Email Prescription and/or Health Benefit details for Empire MediBlue Extra Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $45.00 | Q:60 /30Days | $52.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:60 /30Days | $52.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$450 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:60 /30Days | $52.21 |
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 |
Hamaspik Medicare Choice (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Hamaspik Medicare Choice (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $44.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Hamaspik Medicare Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Hamaspik Medicare Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $46.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:90 /30Days | $24.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:90 /30Days | $24.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Longevity Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $24.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
MetroPlus Advantage Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for MetroPlus Advantage Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $13.43 |
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 |
MetroPlus UltraCare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for MetroPlus UltraCare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $13.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Whole Health of New York NHC (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health of New York NHC (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $40.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Choice (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $33.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Choice (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $29.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $30.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $29.22 |
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 Nursing Home Plan 1 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $29.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
VillageCareMAX Medicare Health Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VillageCareMAX Medicare Health Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $22.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
VillageCareMAX Medicare Health Advantage FLEX (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VillageCareMAX Medicare Health Advantage FLEX (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $22.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
VNS Health EasyCare Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VNS Health EasyCare Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $22.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
VNS Health Total (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VNS Health Total (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $23.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access Open (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $72.34 |
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 3 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.00 |
$100* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$14.00 | $0.00 | None | $29.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | None | $25.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | None | $24.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Essential (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | None | $27.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Plan 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Plan 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$12.00 | $0.00 | None | $34.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$82.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | None | $29.83 |
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 |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$97.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:60 /30Days | $16.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Ultra Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Premium Ultra Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$115.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $46.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$121.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $24.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$121.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $24.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$121.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $27.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$121.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $23.46 |
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 |
VillageCareMAX Medicare Total Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for VillageCareMAX Medicare Total Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $22.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
MetroPlus Platinum Plan (HMO)
![Email Prescription and/or Health Benefit details for MetroPlus Platinum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$142.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $13.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
EmblemHealth VIP Gold Plus (HMO)
![Email Prescription and/or Health Benefit details for EmblemHealth VIP Gold Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$254.00 |
$200* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $24.50 |
Browse Plan Formulary all covered insulin pay $35 or less |