VARENICLINE 0.5 MG TABLET [Chantix] (11 TABLETS ) (NDC: 49884015576)
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 |
Humana Gold Plus H4007-012 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H4007-020 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H4007-021 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H4007-024 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H4007-025 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:56 /28Days | $70.28 |
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 |
Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H4007-022 (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H4007-026 (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:56 /28Days | $70.28 |
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 |
MCS Classicare Acceso (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$5.00 | $10.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Activo (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$5.00 | $10.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare CeroCeroCero (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Efectivo (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$4.00 | $8.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Electrico (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$5.00 | $10.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare En Tu Casa (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$5.00 | $10.00 | Q:56 /28Days | $46.11 |
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 |
MCS Classicare En Tu Hogar (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$5.00 | $10.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Essential (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Exacto (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Firme (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Freedom (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$10.00 | $20.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Hero (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $60.00 | Q:56 /28Days | $46.11 |
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 |
MCS Classicare InteliCare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Platino @Home (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Platino Ideal (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Platino MasCa$h (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Platino Progreso (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Platino Solido (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:56 /28Days | $46.11 |
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 |
MCS Classicare Platino Total (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare Primero (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MCS Classicare SuperRx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$15.00 | $30.00 | Q:56 /28Days | $46.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Balance (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Deluxe (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Diamante Platino (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MMM Dinamico (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Dorado Platino (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Elite (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Encanto (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Flexi Max (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Grande Platino (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MMM Integral (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Plenitud (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Relax Platino (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Supremo (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Valor Platino (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Vibrante (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PMC Max (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
PMC Premier Platino (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S AhorroMax (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$25.00 | $50.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Brillante (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$10.00 | $20.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Contigo Plus (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Enlace Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$10.00 | $20.00 | P Q:336 /365Days | $87.52 |
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 |
Triple S Magno (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$5.00 | $10.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Optimo Plus (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$25.00 | $50.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Platino Advance (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Platino Alcance (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Platino Blindao (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Platino Plus (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:336 /365Days | $87.52 |
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 |
Triple S Platino Titan (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Platino Ultra (HMO D-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Real (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Unico (HMO-POS)
|
$15.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:60 /30Days | $73.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Value H2029-001 (PPO)
|
$38.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:56 /28Days | $70.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Optimo Xtra (PPO)
|
$40.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$15.00 | $30.00 | P Q:336 /365Days | $87.52 |
Browse Plan Formulary all covered insulin pay $35 or less |