CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo] (UNITS ) (NDC: 00093537601)
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 MA-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC MA-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:180 /30Days | $101.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MA-0005 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC MA-0005 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:180 /30Days | $101.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Discover Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | P Q:180 /30Days | $108.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Explorer Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:180 /30Days | $108.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:180 /30Days | $108.76 |
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 |
CCA Medicare Preferred (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | None | $180.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA One Care (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for CCA One Care (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $174.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Forever (HMO)
![Email Prescription and/or Health Benefit details for eternalHealth Forever (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$185 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $103.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Freedom (PPO)
![Email Prescription and/or Health Benefit details for eternalHealth Freedom (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$185 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $103.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Give Back (PPO)
![Email Prescription and/or Health Benefit details for eternalHealth Give Back (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $103.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Orange (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Orange (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $103.01 |
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 |
Mass General Brigham Advantage (PPO)
![Email Prescription and/or Health Benefit details for Mass General Brigham Advantage (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | None | $108.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue SaverRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue SaverRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $16.00 | P Q:180 /30Days | $77.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue SaverRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue SaverRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | P Q:180 /30Days | $77.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Health One Care (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Tufts Health One Care (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $103.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred Access Rx (PPO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred Access Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$4.00 | $8.00 | None | $103.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Saver Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Saver Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$4.00 | $8.00 | None | $103.01 |
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 |
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Smart Saver Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$2.00 | $4.00 | None | $103.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Connected(r) for One Care (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Connected(r) for One Care (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | Q:180 /30Days | $60.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
47% | 47% | Q:180 /30Days | $95.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
48% | 48% | Q:180 /30Days | $95.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
43% | 43% | Q:180 /30Days | $95.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Whole Health NHC (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health NHC (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:180 /30Days | $67.92 |
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 |
CCA Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $180.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Health Plan Senior Care Options (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Tufts Health Plan Senior Care Options (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $103.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Health Plan Senior Care Options CW (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Tufts Health Plan Senior Care Options CW (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $103.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth ForeverMore (HMO)
![Email Prescription and/or Health Benefit details for eternalHealth ForeverMore (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$170 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $103.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Senior Care Options MA-Y001 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Senior Care Options MA-Y001 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:180 /30Days | $60.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | P Q:180 /30Days | $108.76 |
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 |
Medicare HMO Blue ValueRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue ValueRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$6.00 | $12.00 | P Q:180 /30Days | $74.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue ValueRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue ValueRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$320* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$6.00 | $12.00 | P Q:180 /30Days | $102.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Whole Health (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Whole Health (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:180 /30Days | $67.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Senior Care Options NHC MA-Y002 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Senior Care Options NHC MA-Y002 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:180 /30Days | $60.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Senior Care Options (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CCA Senior Care Options (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | 25% | None | $180.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Longevity Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $104.54 |
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 MA-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC MA-0002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:180 /30Days | $101.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Basic Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Basic Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.00 |
$225* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$4.00 | $8.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Basic Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Basic Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.00 |
$225* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$4.00 | $8.00 | None | $103.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Basic Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Basic Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.00 |
$225* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$4.00 | $8.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mass General Brigham Advantage Secure (HMO-POS)
![Email Prescription and/or Health Benefit details for Mass General Brigham Advantage Secure (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | None | $108.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NG-0001 (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC NG-0001 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:180 /30Days | $62.33 |
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 |
Fallon Medicare Plus Super Saver (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Super Saver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$9.00 | $18.00 | None | $103.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue ValueRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue ValueRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$6.00 | $12.00 | P Q:180 /30Days | $74.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue ValueRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue ValueRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$6.00 | $12.00 | P Q:180 /30Days | $102.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Enhanced Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Premium Enhanced Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$75.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
48% | 48% | Q:180 /30Days | $95.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Green (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Green (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$175* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Green (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Green (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$175* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $101.51 |
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 |
Fallon Medicare Plus Green (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Green (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$175* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$7.00 | $14.00 | None | $103.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue FlexRx (HMO-POS)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue FlexRx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$260* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | P Q:180 /30Days | $74.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue FlexRx (HMO-POS)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue FlexRx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$78.00 |
$260* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | P Q:180 /30Days | $102.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mass General Brigham Advantage Premier (PPO)
![Email Prescription and/or Health Benefit details for Mass General Brigham Advantage Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$140.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | None | $108.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Value Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Value Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$4.00 | $8.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Value Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Value Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$4.00 | $8.00 | None | $103.37 |
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 |
Tufts Medicare Preferred HMO Value Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Value Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$4.00 | $8.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Blue (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Blue (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$174.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Blue (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Blue (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$174.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Blue (HMO)
![Email Prescription and/or Health Benefit details for Fallon Medicare Plus Blue (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$174.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$7.00 | $14.00 | None | $103.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$186.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$186.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $103.37 |
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 |
Tufts Medicare Preferred HMO Prime Rx (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$186.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue PlusRx (HMO)
![Email Prescription and/or Health Benefit details for Medicare HMO Blue PlusRx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$220.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | P Q:180 /30Days | $77.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$220.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$4.00 | $8.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$220.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$4.00 | $8.00 | None | $103.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
![Email Prescription and/or Health Benefit details for Tufts Medicare Preferred HMO Prime Rx Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$220.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$4.00 | $8.00 | None | $101.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue PlusRx (PPO)
![Email Prescription and/or Health Benefit details for Medicare PPO Blue PlusRx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$238.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $10.00 | P Q:180 /30Days | $77.11 |
Browse Plan Formulary all covered insulin pay $35 or less |