BUPRENORPHINE 7.5 MCG/HR PATCH [Butrans] (PATCHES ) (NDC: 69238150502)
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 GA-0004 (PPO)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $171.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC GA-0005 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $171.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days | $80.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essential (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days | $95.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | P Q:4 /28Days | $227.11 |
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 |
Aetna Medicare Giveback Choice Plus (PPO)
|
$0.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | P Q:4 /28Days | $227.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Signature (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days | $91.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Grocery (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $304.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $306.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $306.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:4 /28Days | $259.34 |
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 |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:4 /28Days | $259.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:4 /28Days | $259.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:4 /28Days | $228.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Choice Plan (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:4 /28Days | $255.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Select Plus (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:4 /28Days | $255.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Silver Plan (HMO C-SNP)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:4 /28Days | $254.81 |
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 H4141-017 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $231.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H4141-017 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $238.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$145 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $234.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-154 (PPO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $227.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-203 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $231.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-203 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $250.74 |
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 H5216-279 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $225.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-345 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $227.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R3392-004 (Regional PPO)
|
$0.00 |
$195 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $227.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Basic 1 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $284.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Care Plus (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $284.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care GA-0003 (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $171.35 |
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 Medicare Advantage GA-0002 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $172.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$18.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $234.56 |
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% | Q:4 /28Days | $162.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care GS-001A (Regional PPO C-SNP)
|
$20.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:4 /28Days | $163.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred GA Medicare (HMO)
|
$25.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
38% | 38% | Q:4 /28Days | $263.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred GA Medicare (HMO)
|
$25.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
38% | 38% | Q:4 /28Days | $255.11 |
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 |
Cigna Preferred Plus Medicare (HMO)
|
$28.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:4 /28Days | $259.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care GS-0002 (Regional PPO C-SNP)
|
$28.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $163.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Grocery (HMO D-SNP)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | P Q:4 /28Days | $296.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$29.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P Q:4 /28Days | $296.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature (HMO D-SNP)
|
$29.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P Q:4 /28Days | $264.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete GA-D002 (HMO-POS D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:4 /28Days | $171.35 |
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 Dual Signature Select (PPO D-SNP)
|
$31.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P Q:4 /28Days | $263.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature Choice (PPO D-SNP)
|
$31.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P Q:4 /28Days | $263.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Extra Help (HMO)
|
$32.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:4 /28Days | $306.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$34.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:4 /28Days | $257.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Signature (PPO)
|
$34.70 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days | $76.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan GA-F001 (PPO I-SNP)
|
$34.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:4 /28Days | $166.15 |
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 |
Clear Spring Health Deluxe Plan (HMO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:4 /28Days | $261.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:4 /28Days | $257.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC GA-0006 (HMO-POS)
|
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $171.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete GA-S001 (PPO D-SNP)
|
$41.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:4 /28Days | $171.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Advantage Medicare Medicaid Plan 1 (HMO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$14.00 | $0.00 | None | $284.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (PPO D-SNP)
|
$43.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | P Q:4 /28Days | $296.05 |
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 SNP-DE H4141-003 (HMO D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | P Q:4 /28Days | $233.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | P Q:4 /28Days | $296.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage 2 (HMO D-SNP)
|
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | P Q:4 /28Days | $296.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareSource Dual Advantage (HMO D-SNP)
|
$44.20 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
25% | 25% | P Q:4 /28Days | $265.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-280 (PPO)
|
$44.20 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $231.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-280 (PPO)
|
$44.20 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $216.55 |
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 SNP-DE H5216-205 (PPO D-SNP)
|
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | P Q:4 /28Days | $234.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-206 (PPO D-SNP)
|
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | P Q:4 /28Days | $234.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage GA-E001 (PPO I-SNP)
|
$44.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $167.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete GA-V001 (PPO D-SNP)
|
$44.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:4 /28Days | $171.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Advantra Preferred (PPO)
|
$46.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days | $87.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-073 (PPO)
|
$55.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $229.48 |
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 |
Anthem Medicare Advantage 2 (PPO)
|
$59.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:4 /28Days | $306.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage GS-0001 (Regional PPO)
|
$62.00 |
$345 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:4 /28Days | $163.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Enhanced 1 (HMO)
|
$66.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $284.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R3392-002 (Regional PPO)
|
$92.00 |
$340 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:4 /28Days | $227.86 |
Browse Plan Formulary all covered insulin pay $35 or less |