OXYCODONE HCL 5 MG CAPSULE [OxyIR] (30 CAPSULES ) (NDC: 62559016701)
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 |
Advantage Care by Ultimate (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Advantage Care by Ultimate (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | $0.00 | None | $19.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Advantage Care COPD by Ultimate (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | $0.00 | None | $19.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:180 /30Days | $23.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:180 /30Days | $23.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:180 /30Days | $20.81 |
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 (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:180 /30Days | $21.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Circle (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare Circle (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $212.50 | Q:180 /30Days | $7.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Bright Advantage Health Dollars Plan (HMO)
![Email Prescription and/or Health Benefit details for Bright Advantage Health Dollars Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:360 /30Days | n/a |
Browse Plan Formulary all covered insulin pay $35 or less |
Bright Advantage Part B Savings Plan (HMO)
![Email Prescription and/or Health Benefit details for Bright Advantage Part B Savings Plan (HMO)](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 | $94.00 | Q:360 /30Days | n/a |
Browse Plan Formulary all covered insulin pay $35 or less |
Bright Advantage Part B Savings Plan (PPO)
![Email Prescription and/or Health Benefit details for Bright Advantage Part B Savings Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$110 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:360 /30Days | n/a |
Browse Plan Formulary all covered insulin pay $35 or less |
CareBreeze (HMO C-SNP)
![Email Prescription and/or Health Benefit details for CareBreeze (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.52 |
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 |
CareBreeze Platinum (HMO C-SNP)
![Email Prescription and/or Health Benefit details for CareBreeze Platinum (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$70.00 | $200.00 | Q:360 /30Days | $31.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareComplete (HMO C-SNP)
![Email Prescription and/or Health Benefit details for CareComplete (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareComplete Platinum (HMO C-SNP)
![Email Prescription and/or Health Benefit details for CareComplete Platinum (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$70.00 | $200.00 | Q:360 /30Days | $31.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareFree Platinum (HMO)
![Email Prescription and/or Health Benefit details for CareFree Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.51 |
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 |
CareOne Platinum (HMO)
![Email Prescription and/or Health Benefit details for CareOne Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareOne Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for CareOne Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Orlando (PPO)
![Email Prescription and/or Health Benefit details for Devoted CHOICE Orlando (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $35.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Orlando (HMO)
![Email Prescription and/or Health Benefit details for Devoted CORE Orlando (HMO)](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:180 /30Days | $35.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted ESSENTIALS Orlando (HMO)
![Email Prescription and/or Health Benefit details for Devoted ESSENTIALS Orlando (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $0.00 | Q:180 /30Days | $35.88 |
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 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:360 /30Days | $31.49 |
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 |
Humana Gold Plus H1036-146 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-146 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:360 /30Days | $31.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-269 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-269 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:360 /30Days | $31.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-072 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H5216-072 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:360 /30Days | $31.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-304 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H5216-304 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:360 /30Days | $31.51 |
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:180 /30Days | $37.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care Select (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Choice Care Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$450 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $40.00 | Q:180 /30Days | $37.67 |
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 Connect Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Connect Care (HMO C-SNP)](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 | $300.00 | Q:180 /30Days | $37.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
![Email Prescription and/or Health Benefit details for Premier by Ultimate (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | $0.00 | None | $19.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Simply Care (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 |
$4.00 | n/a | Q:180 /30Days | $27.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Simply Comfort (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | n/a | Q:180 /30Days | $27.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
![Email Prescription and/or Health Benefit details for Simply Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:180 /30Days | $27.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
![Email Prescription and/or Health Benefit details for Simply Freedom (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:180 /30Days | $27.58 |
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 |
Simply Level (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Simply Level (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:180 /30Days | $27.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
![Email Prescription and/or Health Benefit details for Simply More (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:180 /30Days | $27.58 |
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 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $4.93 |
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 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $4.93 |
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 |
$100* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $5.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty Giveback (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Specialty Giveback (HMO C-SNP)](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:180 /30Days | $5.88 |
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 Specialty No Premium (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Specialty No Premium (HMO C-SNP)](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:180 /30Days | $5.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5826-074 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-074 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:360 /30Days | $31.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareNeeds Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CareNeeds Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:360 /30Days | $31.51 |
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) |
$18.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:180 /30Days | $36.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.40 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:180 /30Days | $29.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:360 /30Days | $31.49 |
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 |
Humana Fully Integrated H1036-280 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Fully Integrated H1036-280 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:360 /30Days | $31.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted DUAL Orlando (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Devoted DUAL Orlando (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.90 |
$505 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | 25% | Q:180 /30Days | $35.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
![Email Prescription and/or Health Benefit details for Devoted PRIME (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $35.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
![Email Prescription and/or Health Benefit details for Devoted PRIME (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $35.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
![Email Prescription and/or Health Benefit details for Devoted PRIME (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $35.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
![Email Prescription and/or Health Benefit details for Devoted PRIME (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $35.88 |
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 |
Devoted PRIME (HMO)
![Email Prescription and/or Health Benefit details for Devoted PRIME (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $35.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
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) |
$35.20 |
$505 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
36% | 36% | Q:180 /30Days | $37.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Advantage Plus by Ultimate (Full) (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
25% | 25% | None | $19.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Advantage Plus by Ultimate (Partial) (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
25% | 25% | None | $19.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Florida Complete Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Florida Complete Care (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:180 /30Days | $41.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Florida Complete Care- In The Community (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Florida Complete Care- In The Community (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:180 /30Days | $41.40 |
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 (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) |
$35.90 |
$505 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
35% | 35% | Q:180 /30Days | $37.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Simply Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$15.00 | $45.00 | Q:180 /30Days | $35.28 |
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) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:180 /30Days | $36.49 |
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) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:180 /30Days | $36.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Reserve (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Reserve (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:180 /30Days | $32.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Enhanced Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Premium Enhanced Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:180 /30Days | $5.06 |
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 R5826-005 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-005 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$111.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:360 /30Days | $31.52 |
Browse Plan Formulary all covered insulin pay $35 or less |