JENTADUETO 2.5 MG-1000 MG TABLET (60.000 EA ) (NDC: 00597014860)
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 |
Aetna Medicare MyMichigan Prime (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $555.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $560.82 |
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. | 3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $560.82 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $518.66 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $518.47 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $516.58 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $518.48 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $515.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP Medicare Flex (PPO)
|
$0.00 |
$505 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.66 |
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. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.90 |
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. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.90 |
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 |
HAP Senior Plus Option 1 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-306 (PPO)
|
$0.00 |
$350 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $563.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H8087-004 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $564.31 |
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. | 3 |
Preferred Brand |
$47.00 | $105.75 | Q:60 /30Days | $506.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Flex (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $105.75 | Q:60 /30Days | $506.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Flex (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $105.75 | Q:60 /30Days | $506.31 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $523.88 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $518.02 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $517.76 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $517.72 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $515.19 |
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 | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $509.58 |
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 |
PriorityMedicare Edge (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $506.22 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $511.34 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $507.34 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $506.22 |
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 |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $509.58 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $509.58 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $506.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H8087-001 (PPO)
|
$19.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $564.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H8087-002 (PPO)
|
$23.90 |
$260 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $564.31 |
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 |
McLaren Medicare Inspire Plus (HMO)
|
$25.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $105.75 | Q:60 /30Days | $506.44 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $509.58 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $511.34 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $507.34 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $506.22 |
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 |
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:60 /30Days | $506.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H8087-003 (PPO D-SNP)
|
$32.70 |
$505 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $564.22 |
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 | 3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days | $502.82 |
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 | 3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days | $502.82 |
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 | 3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $500.82 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $506.22 |
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 |
PriorityMedicare Value (HMO-POS)
|
$34.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $507.34 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $511.34 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $509.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP Senior Plus Option 2 (PPO)
|
$70.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-009 (PPO)
|
$70.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $564.62 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $509.58 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $506.22 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $507.34 |
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 | 3 |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days | $511.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $517.76 |
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)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $518.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $523.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $517.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $515.19 |
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 | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $506.22 |
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 | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $507.34 |
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 | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $511.34 |
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 | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$38.00 | $95.00 | Q:60 /30Days | $509.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R3887-002 (Regional PPO)
|
$87.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
18% | 18% | Q:60 /30Days | $563.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP Senior Plus Option 1 (HMO-POS)
|
$99.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $518.48 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $515.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $518.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $516.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $518.47 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $517.72 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $515.19 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $523.88 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $518.02 |
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. | 3 |
Preferred Brand |
$42.00 | $116.00 | Q:180 /90Days | $517.76 |
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 | 3 |
Preferred Brand |
$37.00 | $92.50 | Q:60 /30Days | $513.55 |
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 | 3 |
Preferred Brand |
$37.00 | $92.50 | Q:60 /30Days | $507.34 |
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 | 3 |
Preferred Brand |
$37.00 | $92.50 | Q:60 /30Days | $509.58 |
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 |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$37.00 | $92.50 | Q:60 /30Days | $511.34 |
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 | 3 |
Preferred Brand |
$37.00 | $92.50 | Q:60 /30Days | $506.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP Senior Plus Option 3 (PPO)
|
$165.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP Senior Plus Option 4 (PPO)
|
$180.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
HAP Senior Plus Option 2 (HMO-POS)
|
$190.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $105.00 | None | $496.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $518.66 |
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)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $518.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $516.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $515.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$38.00 | $105.00 | Q:180 /90Days | $518.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $101.00 | Q:180 /90Days | $515.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $101.00 | Q:180 /90Days | $517.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $101.00 | Q:180 /90Days | $523.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $101.00 | Q:180 /90Days | $518.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $101.00 | Q:180 /90Days | $517.76 |
Browse Plan Formulary all covered insulin pay $35 or less |