GENTAMICIN 0.1% OINTMENT (15 GRAMS ) (NDC: 00713068215)
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. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $25.43 |
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. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $25.43 |
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. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $25.72 |
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 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $25.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
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) |
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $11.48 |
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 |
Aetna Medicare Select Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $11.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Align Connect (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Align Connect (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | Q:120 /30Days | $35.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Align Thrive (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Align Thrive (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | Q:120 /30Days | $35.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue + Kroger (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue + Kroger (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$35.00 | $105.00 | Q:30 /30Days | $22.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue + Kroger Access (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue + Kroger Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $22.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days | $22.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem MediBlue Care on Site (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Care on Site (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$7.50 | $0.00 | Q:30 /30Days | $28.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue COPD (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue COPD (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$9.50 | $0.00 | Q:30 /30Days | $22.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Diabetes and Heart Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Diabetes and Heart Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$7.50 | $0.00 | Q:30 /30Days | $22.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue ESRD Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue ESRD Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:30 /30Days | $22.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Local (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Local (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$9.50 | $0.00 | Q:30 /30Days | $22.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Smart Fit (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Smart Fit (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 |
$12.50 | $0.00 | Q:30 /30Days | $22.22 |
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 |
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 | None | $30.89 |
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 |
$42.00 | $126.00 | None | $30.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Essential (HMO)
![Email Prescription and/or Health Benefit details for Clear Spring Health Essential (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 | $39.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Essential (PPO)
![Email Prescription and/or Health Benefit details for Clear Spring Health Essential (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 | $126.00 | Q:60 /30Days | $39.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $29.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-139 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-139 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $29.17 |
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 H5619-139 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-139 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $28.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-004 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-004 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $29.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-266 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-266 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $29.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-308 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-308 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$485 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $29.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-312 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-312 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $29.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Choice Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $24.00 | Q:30 /30Days | $29.85 |
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 |
Optima Medicare Value (HMO)
![Email Prescription and/or Health Benefit details for Optima Medicare Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
3* |
Preferred Brand |
$42.00 | $84.00 | Q:60 /30Days | $35.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $29.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-074 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-074 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $29.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-074 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-074 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $29.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Value (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Value (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $22.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Premier (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Premier (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.20 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $22.03 |
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 |
Anthem MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Dual Advantage (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 |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $22.24 |
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) |
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $25.43 |
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) |
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $25.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Virginia Premier Advantage Elite (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Virginia Premier Advantage Elite (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $34.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Optima Community Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Optima Community Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.40 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $34.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Extra (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.90 |
$505 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $22.22 |
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 |
Aetna Better Health of Virginia (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Better Health of Virginia (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $22.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Plus Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $30.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Plus Medicare (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $30.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Dual Access (PPO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Dual Access (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.40 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $22.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $25.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Assisted Living Plan (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $25.48 |
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 ONE Plus (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete ONE Plus (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $25.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $25.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Align Kidney Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Align Kidney Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.50 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | Q:120 /30Days | $36.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Balance (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete Balance (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $25.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem MediBlue Full Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Full Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $22.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $29.85 |
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 |
Molina Medicare Complete Care Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$29.00 | $87.00 | Q:30 /30Days | $29.85 |
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) |
$34.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $25.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $25.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-144 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-144 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$265 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $28.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-004 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-004 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $29.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essential Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Essential Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $11.38 |
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 R1390-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R1390-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $29.07 |
Browse Plan Formulary all covered insulin pay $35 or less |