SEROQUEL 150 MG TABLET (30 TABLETS ) (NDC: 16571080901)
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)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Choice Plan 2 (Regional PPO)
|
$0.00 |
$195* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $43.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Credit (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $43.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $43.31 |
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 |
Aetna Medicare Select (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $43.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Access (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$30.00 | $75.00 | None | $40.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$25.00 | $62.50 | None | $40.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Circle (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$0.00 | $0.00 | None | $40.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | P Q:150 /30Days | $47.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$50.00 | $150.00 | P Q:150 /30Days | $47.01 |
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 |
BlueMedicare Saver (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$50.00 | $150.00 | P Q:150 /30Days | $47.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:150 /30Days | $47.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareBreeze (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareBreeze Platinum (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareComplete (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareComplete Platinum (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $49.25 |
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 |
CareFree (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareFree Platinum (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareOne Plus (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $47.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $47.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $47.52 |
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 |
Devoted CORE Miami-Dade (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted ESSENTIALS Miami-Dade (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
DrExtraCare (HMO-POS C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$40.00 | $120.00 | Q:30 /30Days | $39.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
DrMax (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$45.00 | $135.00 | Q:30 /30Days | $39.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
DrValue (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:30 /30Days | $39.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthSun HealthAdvantage Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:150 /30Days | $39.39 |
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 |
HealthSun HealthAdvantage Plus (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:150 /30Days | $39.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-305 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Lung (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-068 (PPO)
|
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
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 |
HumanaChoice Florida H5216-311 (PPO)
|
$0.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H7284-008 (PPO)
|
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Leon MediExtra (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | n/a | Q:30 /30Days | $40.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Leon MediMore (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Generic |
$0.00 | n/a | Q:30 /30Days | $40.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedicareMax (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedicareMax Chronic (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $40.01 |
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 Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $24.00 | None | $41.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care Select (HMO)
|
$0.00 |
$450 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $40.00 | None | $41.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Connect Care (HMO C-SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | None | $41.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
PHP (HMO C-SNP)
|
$0.00 |
$505 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic |
15% | n/a | Q:30 /30Days | $39.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Preferred Choice Dade (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Preferred Special Care Miami-Dade (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:90 /30Days | $40.01 |
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 Care (HMO I-SNP)
|
$0.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$4.00 | n/a | Q:150 /30Days | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$505* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | n/a | Q:150 /30Days | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:150 /30Days | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:150 /30Days | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:150 /30Days | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:150 /30Days | $41.60 |
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 Giveback (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $40.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $40.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty Giveback (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $40.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5826-074 (Regional PPO)
|
$4.00 |
$395* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$20.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H7284-007 (PPO)
|
$10.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareNeeds Plus (HMO D-SNP)
|
$18.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $0.00 | Q:30 /30Days | $49.25 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$18.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $40.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$20.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:90 /30Days | $47.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$20.10 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $47.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus (HMO D-SNP)
|
$24.40 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$11.00 | $33.00 | Q:90 /30Days | $43.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Reserve (HMO D-SNP)
|
$28.50 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $40.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Fully Integrated H1036-280 (HMO D-SNP)
|
$28.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$16.00 | $0.00 | Q:30 /30Days | $49.25 |
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 |
UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)
|
$30.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$30.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $40.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure (HMO D-SNP)
|
$32.00 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $45.00 | Q:90 /30Days | $43.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
|
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
|
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
|
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $41.60 |
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)
|
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME (HMO)
|
$32.00 |
$505* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.60 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $40.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted DUAL Miami-Dade (HMO D-SNP)
|
$32.90 |
$505 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
25% | 25% | None | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)
|
$35.20 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$16.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$35.20 |
$505 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $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 |
AmeriHealth Caritas VIP Care (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$6.75 | $20.25 | Q:60 /30Days | $35.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | P Q:150 /30Days | $47.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
DrPlus (HMO-POS D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:30 /30Days | $39.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Florida Complete Care (HMO I-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $41.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Florida Complete Care- In The Community (HMO I-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $41.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthSun MediMax (HMO)
|
$35.90 |
$430 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | Q:150 /30Days | $41.60 |
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 |
HealthSun MediSun Extra (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | Q:150 /30Days | $41.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Leon MediDual (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
24% | n/a | Q:30 /30Days | $40.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:90 /30Days | $44.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedicareMax Plus (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:90 /30Days | $40.01 |
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)
|
$35.90 |
$505 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $41.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Preferred Medicare Assist (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$15.00 | $45.00 | Q:150 /30Days | $39.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $40.01 |
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 RP (Regional PPO D-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
|
$35.90 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:90 /30Days | $40.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Choice (Regional PPO)
|
$49.90 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | P Q:150 /30Days | $47.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5826-005 (Regional PPO)
|
$111.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $0.00 | Q:30 /30Days | $49.25 |
Browse Plan Formulary all covered insulin pay $35 or less |