ALBUTEROL SULF 2 MG/5 ML SYRUP (120 MLS ) (NDC: 00472082516)
2024 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 from UHC IN-0007 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $8.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $8.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $8.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $8.11 |
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. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $5.69 |
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 SmartFit (PPO)
|
$0.00 |
$250 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
50% | 50% | None | $5.57 |
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. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $5.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.16 |
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 |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage CSNP (HMO C-SNP)
|
$0.00 |
$545* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$17.00 | $45.00 | None | $8.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage CSNP (HMO C-SNP)
|
$0.00 |
$545* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$17.00 | $45.00 | None | $8.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage CSNP (HMO C-SNP)
|
$0.00 |
$545* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$17.00 | $45.00 | None | $8.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$17.00 | $0.00 | None | $5.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$0.00 | $0.00 | None | $5.02 |
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 USAA Honor with Rx (PPO)
|
$0.00 |
$350* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$5.00 | $0.00 | None | $5.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 2 |
Generic |
$5.00 | $0.00 | None | $5.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$8.00 | $0.00 | None | $5.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$5.00 | $0.00 | None | $5.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
MDwise Medicare Inspire (HMO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
MyTruAdvantage Choice Plus (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.22 |
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 |
MyTruAdvantage Choice Plus (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
MyTruAdvantage Select (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
MyTruAdvantage Select (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
MyTruAdvantage Select Plus (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $7.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $7.20 |
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 No Premium (HMO)
|
$0.00 |
$175 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $7.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $7.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing ESRD Select IN (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$5.00 | $0.00 | None | $7.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Open Choice Diabetes & Heart IN (PPO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$8.00 | $0.00 | None | $7.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Open Choice IN (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $0.00 | None | $7.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IN (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$8.00 | $0.00 | None | $7.82 |
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 |
Zing Select Diabetes & Heart IN (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$8.00 | $0.00 | None | $7.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $7.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Extra Help (HMO)
|
$16.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$10.00 | $30.00 | None | $4.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $94.00 | None | $7.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $5.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage Sapphire (HMO)
|
$22.00 |
$545* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$8.00 | $24.00 | None | $8.33 |
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 |
CommuniCare Advantage Sapphire (HMO)
|
$22.00 |
$545* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$8.00 | $24.00 | None | $8.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage Sapphire (HMO)
|
$22.00 |
$545* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$8.00 | $24.00 | None | $8.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $8.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
MDwise Medicare Inspire Plus (HMO)
|
$25.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $8.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$28.00 |
$400 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
40% | 40% | None | $5.57 |
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 |
Anthem Medicare Advantage 2 (PPO)
|
$28.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$29.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $5.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $7.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $8.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $7.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $5.77 |
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 Assure Premier (HMO D-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $4.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Indiana (HMO I-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $8.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage Aligned (HMO D-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | None | $5.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage ISNP (HMO I-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $8.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage ISNP (HMO I-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $7.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage ISNP (HMO I-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $8.05 |
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 Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$0.00 | $0.00 | None | $5.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$0.00 | $0.00 | None | $5.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
$0.00 | $0.00 | None | $5.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$8.00 | $0.00 | None | $5.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $8.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $8.11 |
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 |
Zing Choice Diabetes & Heart Complete IN (PPO C-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | 0% | None | $7.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IN (HMO C-SNP)
|
$42.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
25% | 0% | None | $7.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R0865-003 (Regional PPO)
|
$46.00 |
$245* | Yes, this drug has Gap Coverage. | 2* |
Generic |
$5.00 | $0.00 | None | $5.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
MDwise Medicare Inspire Flex (HMO-POS)
|
$49.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage Emerald (HMO)
|
$51.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | $30.00 | None | $8.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
CommuniCare Advantage Emerald (HMO)
|
$51.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | $30.00 | None | $8.05 |
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 |
CommuniCare Advantage Emerald (HMO)
|
$51.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$10.00 | $30.00 | None | $8.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$17.00 | $0.00 | None | $5.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$58.00 |
$60* | Yes, but No Gap Coverage for this drug. | 1* |
Preferred Generic |
$4.00 | $0.00 | None | $4.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (Regional PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 1 |
Preferred Generic |
$6.00 | $0.00 | None | $4.70 |
Browse Plan Formulary all covered insulin pay $35 or less |