RISPERDAL CONSTA FOR INJECTION 12.5MG/VIAL (12.5 MG VIAL DSPK) (NDC: 50458030911)
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 | 4 |
Non-Preferred Drug |
$10.00 | $20.00 | Q:2 /28Days | $291.76 |
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 | 4 |
Non-Preferred Drug |
$15.00 | $35.00 | Q:2 /28Days | $291.76 |
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 | 4 |
Non-Preferred Drug |
$15.00 | $35.00 | Q:2 /28Days | $291.76 |
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 | 4 |
Non-Preferred Drug |
$0.00 | $0.00 | Q:2 /28Days | $291.76 |
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 | 4 |
Non-Preferred Drug |
$0.00 | $0.00 | Q:2 /28Days | $291.76 |
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 |
Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)
|
$0.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:2 /28Days | $291.76 |
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 | 4 |
Tier 4 |
15% | 15% | Q:2 /28Days | $291.76 |
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 | 4 |
Tier 4 |
15% | 15% | Q:2 /28Days | $291.76 |
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 | 4 |
Tier 4 |
15% | 15% | Q:2 /28Days | $291.76 |
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 | 4 |
Tier 4 |
15% | 15% | Q:2 /28Days | $291.76 |
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 | 4 |
Tier 4 |
15% | 15% | Q:2 /28Days | $291.76 |
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 |
MCS Classicare Acceso (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$10.00 | $20.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$15.00 | $30.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$14.00 | $28.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$15.00 | $30.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$15.00 | $30.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$15.00 | $30.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$16.00 | $32.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
25% | 25% | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $306.14 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $306.14 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $306.14 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $306.14 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $306.14 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $306.14 |
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 | 4 |
Tier 4 |
$0.00 | $0.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$30.00 | $60.00 | P Q:2 /28Days | $306.14 |
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. | 4 |
Non-Preferred Brand |
$7.00 | $14.00 | P Q:2 /28Days | $296.63 |
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. | 4 |
Non-Preferred Brand |
$10.00 | $20.00 | P Q:2 /28Days | $296.63 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $296.63 |
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. | 4 |
Non-Preferred Brand |
$16.00 | $32.00 | P Q:2 /28Days | $296.63 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $296.63 |
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. | 4 |
Non-Preferred Brand |
$10.00 | $20.00 | P Q:2 /28Days | $296.63 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $296.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
MMM Integral (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$25.00 | $50.00 | P Q:2 /28Days | $296.63 |
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. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $296.63 |
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 Relax Platino (HMO D-SNP)
|
$0.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $296.63 |
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. | 4 |
Non-Preferred Brand |
$20.00 | $40.00 | P Q:2 /28Days | $296.63 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $296.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
PMC Max (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$10.00 | $20.00 | P Q:2 /28Days | $296.63 |
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 | 4 |
Tier 4 |
15% | 15% | P Q:2 /28Days | $296.63 |
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. | 4 |
Non-Preferred Brand |
$35.00 | $70.00 | S Q:8 /28Days | $289.25 |
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 Brillante (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$20.00 | $40.00 | S Q:8 /28Days | $289.25 |
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. | 4 |
Non-Preferred Brand |
$10.00 | $20.00 | S Q:8 /28Days | $289.25 |
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. | 4 |
Non-Preferred Brand |
$15.00 | $30.00 | S Q:8 /28Days | $289.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Magno (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$25.00 | $50.00 | S Q:8 /28Days | $289.25 |
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. | 4 |
Non-Preferred Brand |
$40.00 | $80.00 | S Q:8 /28Days | $289.25 |
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 | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:8 /28Days | $289.25 |
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 Alcance (HMO D-SNP)
|
$0.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:8 /28Days | $289.25 |
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 | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:8 /28Days | $289.25 |
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 | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:8 /28Days | $289.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Triple S Platino Titan (HMO D-SNP)
|
$0.00 |
$505 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:8 /28Days | $289.25 |
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 | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | S Q:8 /28Days | $289.25 |
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. | 4 |
Non-Preferred Brand |
$5.00 | $10.00 | S Q:8 /28Days | $289.25 |
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 Unico (HMO-POS)
|
$15.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$0.00 | $0.00 | P Q:2 /28Days | $296.63 |
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 | 4 |
Non-Preferred Drug |
$40.00 | $110.00 | Q:2 /28Days | $291.76 |
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. | 4 |
Non-Preferred Brand |
$30.00 | $60.00 | S Q:8 /28Days | $289.25 |
Browse Plan Formulary all covered insulin pay $35 or less |