CELECOXIB 400 MG CAPSULE [Celebrex] (30 CAPSULES ) (NDC: 65862091060)
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 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | Q:60 /30Days | $30.82 |
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) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days | $28.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Rebate (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Rebate (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$14.00 | $0.00 | Q:60 /30Days | $28.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $17.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $17.14 |
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 Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $17.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days | $61.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Saver Choice (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Saver Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | Q:30 /30Days | $61.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (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 |
$42.00 | $126.00 | Q:60 /30Days | $39.81 |
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 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days | $36.73 |
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 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days | $47.16 |
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 |
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 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days | $39.81 |
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 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days | $28.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Advantage (HMO)
![Email Prescription and/or Health Benefit details for Essence Advantage (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 |
$5.00 | $0.00 | Q:60 /30Days | $31.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Essence Advantage Plus (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 |
$9.00 | $0.00 | Q:60 /30Days | $31.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Advantage Blue Classic (HMO)
![Email Prescription and/or Health Benefit details for Health Advantage Blue Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$13.00 | $26.00 | Q:30 /30Days | $55.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Advantage Blue Classic (HMO)
![Email Prescription and/or Health Benefit details for Health Advantage Blue Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$13.00 | $26.00 | Q:30 /30Days | $62.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Advantage Blue Classic (HMO)
![Email Prescription and/or Health Benefit details for Health Advantage Blue Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$13.00 | $26.00 | Q:30 /30Days | $56.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Advantage Blue Premier (HMO)
![Email Prescription and/or Health Benefit details for Health Advantage Blue Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $61.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-111 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-111 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $15.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-231 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-231 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:60 /30Days | $15.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-337 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-337 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:60 /30Days | $15.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-337 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-337 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:60 /30Days | $15.72 |
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 |
HumanaChoice H5216-337 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-337 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:60 /30Days | $15.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Chronic Complete (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Chronic Complete (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $30.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vantage BASIC (HMO-POS)
![Email Prescription and/or Health Benefit details for Vantage BASIC (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $23.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vantage Giveback (HMO-POS)
![Email Prescription and/or Health Benefit details for Vantage Giveback (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $23.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$445 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $43.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Dividend (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Dividend (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 |
$35.00 | $70.00 | Q:30 /30Days | $42.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
3* |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $43.28 |
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 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $49.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Preferred (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Preferred (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 |
$42.00 | $84.00 | Q:30 /30Days | $42.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Silver (Regional PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$7.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $32.49 |
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) |
$17.30 |
$270 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $155.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Gold (Regional PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $0.00 | Q:60 /30Days | $32.49 |
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 Compass (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Assist Compass (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.60 |
$95 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
45% | 45% | Q:30 /30Days | $155.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H9070-005 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H9070-005 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $0.00 | Q:60 /30Days | $15.72 |
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) |
$20.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $139.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Liberty (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $139.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
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) |
$21.00 |
$245* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | Q:60 /30Days | $32.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $40.32 |
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 |
Tribute Select (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for Tribute Select (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $61.85 |
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) |
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $0.00 | Q:60 /30Days | $28.70 |
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) |
$27.40 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $149.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Value Choice (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Value Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$13.00 | $0.00 | Q:30 /30Days | $61.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-122 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-122 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$11.00 | $0.00 | Q:60 /30Days | $15.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Independence (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Independence (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $40.00 | Q:30 /30Days | $61.59 |
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 H5619-123 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $15.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tribute Advantage (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for Tribute Advantage (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $61.85 |
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) |
$31.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $30.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice Select (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Choice Select (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $30.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vantage DUAL PLUS (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for Vantage DUAL PLUS (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $23.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vantage STANDARD (HMO-POS)
![Email Prescription and/or Health Benefit details for Vantage STANDARD (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.90 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $23.03 |
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 Dual Access (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $137.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Liberty (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $137.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Low Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $43.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier Choice (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Premier Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | Q:30 /30Days | $61.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R1532-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R1532-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$16.00 | $0.00 | Q:60 /30Days | $15.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Medicare Advantage Choice Plan 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Choice Plan 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$275* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$15.00 | $0.00 | Q:60 /30Days | $32.49 |
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 H5216-083 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-083 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$195* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $0.00 | Q:60 /30Days | $15.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Preferred (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare Preferred (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $50.00 | Q:30 /30Days | $62.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Preferred (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare Preferred (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $50.00 | Q:30 /30Days | $57.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Preferred (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare Preferred (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $50.00 | Q:30 /30Days | $66.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-122 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-122 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$131.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days | $15.71 |
Browse Plan Formulary all covered insulin pay $35 or less |