FONDAPARINUX 7.5 MG/0.6 ML SYRINGE [Arixtra] (3.6 mls ) (NDC: 67457058406)
2023 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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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 Open Plan 1 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $3,026.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Better Health Premier Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $1,487.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $2,420.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,108.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,374.57 |
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 |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $999.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,148.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,376.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP MSUHC Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | Q:18 /30Days | $1,988.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP Senior Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
48% | 48% | Q:18 /30Days | $1,988.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,213.98 |
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 |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $935.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $906.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $926.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $918.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $901.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
MeridianComplete (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $1,295.01 |
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 |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
31% | n/a | None | $2,124.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care Select (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
27% | n/a | None | $2,124.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
PHP Advantage (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $2,414.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Edge (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,348.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Edge (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,918.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Edge (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,520.90 |
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 |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,348.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,514.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,487.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,918.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,520.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Vital (PPO)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | Q:18 /30Days | $2,348.99 |
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 |
PriorityMedicare Vital (PPO)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | Q:18 /30Days | $1,918.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Vital (PPO)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
26% | n/a | Q:18 /30Days | $2,520.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $2,761.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $2,643.86 |
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. |
5 |
Specialty Tier |
33% | n/a | None | $2,761.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$10.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $2,420.27 |
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 (HMO)
|
$11.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $2,777.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $2,643.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$18.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $839.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$23.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $2,345.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Plus (HMO)
|
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,213.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
PHP Advantage Plus (HMO-POS)
|
$25.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | None | $2,414.69 |
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 |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | Q:18 /30Days | $2,348.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | Q:18 /30Days | $2,514.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | Q:18 /30Days | $2,487.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | Q:18 /30Days | $1,918.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | Q:18 /30Days | $2,520.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO-POS D-SNP)
|
$27.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $839.85 |
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 |
AARP Medicare Advantage Open Plan 2 (PPO)
|
$28.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $3,026.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Duals (HMO D-SNP)
|
$32.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:18 /30Days | $1,213.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$32.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $2,124.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$32.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $2,124.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare D-SNP (HMO D-SNP)
|
$32.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | Q:18 /30Days | $2,330.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
|
$32.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | None | $2,351.28 |
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 Choice (PPO D-SNP)
|
$32.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | None | $2,351.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)
|
$32.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | None | $2,351.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Community Assist (PPO)
|
$32.70 |
$380 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
25% | n/a | None | $2,014.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$34.00 |
$75 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
31% | n/a | Q:18 /30Days | $2,514.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$34.00 |
$75 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
31% | n/a | Q:18 /30Days | $2,487.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$34.00 |
$75 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
31% | n/a | Q:18 /30Days | $1,918.51 |
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 |
PriorityMedicare Value (HMO-POS)
|
$34.00 |
$75 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
31% | n/a | Q:18 /30Days | $2,520.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$34.00 |
$75 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
31% | n/a | Q:18 /30Days | $2,348.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Flex (HMO-POS)
|
$49.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,258.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Flex (HMO-POS)
|
$49.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,241.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$68.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $901.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$68.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $935.00 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$68.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $906.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$68.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $926.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$68.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $918.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$74.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,918.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$74.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,520.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$74.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,348.99 |
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 |
PriorityMedicare Merit (PPO)
|
$74.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,514.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$74.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,487.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$81.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,348.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$81.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,514.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$81.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,487.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$81.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,918.51 |
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 |
PriorityMedicare (HMO-POS)
|
$81.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,520.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$110.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,108.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$110.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,374.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$110.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $999.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$110.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,148.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$110.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,376.83 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $935.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $906.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $926.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $918.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $901.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,348.99 |
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 |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,514.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,487.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $1,918.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | Q:18 /30Days | $2,520.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$240.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,108.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$240.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,374.57 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$240.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $999.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$240.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,148.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$240.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $1,376.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$246.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $935.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$246.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $906.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$246.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $926.45 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$246.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $918.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$246.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
33% | n/a | None | $901.56 |
Browse Plan Formulary all covered insulin pay $35 or less |