RYTARY ER 23.75 MG-95 MG CAPSULE (100.000 EA ) (NDC: 64896066101)
2024 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 |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
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 |
AARP Medicare Advantage from UHC RI-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
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 |
BlueCHiP for Medicare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-062 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-062 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
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 |
HumanaChoice H5525-062 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-063 (PPO)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-063 (PPO)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-063 (PPO)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
|
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,132.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
|
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,132.30 |
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 |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
|
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,132.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
|
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,132.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
|
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,132.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
|
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
|
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
|
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
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 |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
|
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
|
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-061 (PPO)
|
$28.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-061 (PPO)
|
$28.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-061 (PPO)
|
$28.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S Q:360 /30Days | $1,076.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E002 (PPO I-SNP)
|
$33.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,133.70 |
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 |
UHC Care Advantage RI-E002 (PPO I-SNP)
|
$33.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,133.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
|
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
|
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
|
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
|
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
|
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | S | $1,135.24 |
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 |
BlueRI for Duals (HMO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $1,131.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueRI for Duals (HMO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $1,131.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueRI for Duals (HMO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $1,131.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueRI for Duals (HMO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $1,131.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueRI for Duals (HMO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $1,131.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
|
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
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 |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
|
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
|
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
|
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
|
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E001 (PPO I-SNP)
|
$43.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E001 (PPO I-SNP)
|
$43.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.38 |
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 |
UHC Care Advantage RI-E001 (PPO I-SNP)
|
$43.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | S | $1,135.24 |
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 |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | S | $1,135.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Standard with Drugs (HMO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
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 |
BlueCHiP for Medicare Standard with Drugs (HMO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Standard with Drugs (HMO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Standard with Drugs (HMO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Standard with Drugs (HMO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NG-0001 (Regional PPO)
|
$58.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | S | $1,135.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Extra (HMO-POS)
|
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
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 |
BlueCHiP for Medicare Extra (HMO-POS)
|
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Extra (HMO-POS)
|
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Extra (HMO-POS)
|
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Extra (HMO-POS)
|
$105.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Plus (HMO)
|
$130.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Plus (HMO)
|
$130.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
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 |
BlueCHiP for Medicare Plus (HMO)
|
$130.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Plus (HMO)
|
$130.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Plus (HMO)
|
$130.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthMate for Medicare (PPO)
|
$143.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthMate for Medicare (PPO)
|
$143.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthMate for Medicare (PPO)
|
$143.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
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 |
HealthMate for Medicare (PPO)
|
$143.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthMate for Medicare (PPO)
|
$143.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Preferred (HMO-POS)
|
$237.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Preferred (HMO-POS)
|
$237.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Preferred (HMO-POS)
|
$237.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueCHiP for Medicare Preferred (HMO-POS)
|
$237.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
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 |
BlueCHiP for Medicare Preferred (HMO-POS)
|
$237.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | None | $1,102.63 |
Browse Plan Formulary all covered insulin pay $35 or less |