DONEPEZIL HCL ODT 10 MG TABLET (30 EA ) (NDC: 33342003007)
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 VA-0005 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0005 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$14.00 | $0.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0011 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0011 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$14.00 | $0.00 | Q:60 /30Days | $11.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0011 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0011 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$14.00 | $0.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0013 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0013 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$14.00 | $0.00 | Q:60 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0017 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0017 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$14.00 | $0.00 | Q:60 /30Days | $11.23 |
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 Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $1.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Select Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $1.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare SmartFit (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $1.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Grocery (HMO)
![Email Prescription and/or Health Benefit details for Anthem Grocery (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $26.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Grocery (PPO)
![Email Prescription and/or Health Benefit details for Anthem Grocery (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $26.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Kidney Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem Kidney Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $26.13 |
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)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $26.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$4.00 | $0.00 | Q:60 /30Days | $21.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Medicare (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 | $0.00 | Q:60 /30Days | $21.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Essential (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Clear Spring Health Essential (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $15.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Essential (HMO)
![Email Prescription and/or Health Benefit details for Clear Spring Health Essential (HMO)](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 | $15.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Essential (PPO)
![Email Prescription and/or Health Benefit details for Clear Spring Health Essential (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 | $17.48 |
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 |
Humana Gold Choice H8145-004 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-004 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | $0.00 | Q:30 /30Days | $10.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$145* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-157 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-157 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-004 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-004 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-083 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-083 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.52 |
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 |
HumanaChoice H5216-266 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-266 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-308 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-308 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-312 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-312 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
LifeWorks Premier Care (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for LifeWorks Premier Care (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | n/a | Q:30 /30Days | $24.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Memory Care (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Memory Care (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $6.00 | Q:30 /30Days | $30.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Choice Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $8.71 |
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 |
Premier Care (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for Premier Care (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $6.00 | Q:30 /30Days | $30.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Medicare Value (HMO)
![Email Prescription and/or Health Benefit details for Sentara Medicare Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $18.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Community Complete Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Sentara Community Complete Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $18.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Community Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Sentara Community Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $18.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
![Email Prescription and/or Health Benefit details for Humana Together in Health (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $10.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$10.00 | $0.00 | Q:30 /30Days | $10.50 |
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)
![Email Prescription and/or Health Benefit details for Cigna Preferred Plus Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$4.00 | $0.00 | Q:60 /30Days | $21.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Plus Medicare (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$4.00 | $0.00 | Q:60 /30Days | $21.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Extra Help (HMO)
![Email Prescription and/or Health Benefit details for Anthem Extra Help (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.10 |
$545* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $26.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0012 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0012 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | Q:60 /30Days | $11.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0012 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0012 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $20.73 |
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 Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $8.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Value (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Value (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $4.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F004 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan EX-F004 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $11.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $8.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Better Health of Virginia (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Better Health of Virginia (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $4.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Premier (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Premier (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $4.30 |
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 |
Align Kidney Care (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Align Kidney Care (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | Q:30 /30Days | $30.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (PPO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Dual Advantage (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $20.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Full Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $20.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage 2 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Full Dual Advantage 2 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $20.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage Support (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Full Dual Advantage Support (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $20.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-085 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-085 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.50 |
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 H5216-363 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-363 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $10.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Senior Care (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:30 /30Days | $24.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-Q001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-Q001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $10.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-S001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-S001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $10.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-S002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-S002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $10.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $10.93 |
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 VA-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $10.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-Y002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-Y002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $10.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-144 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-144 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$265* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days | $10.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage VA-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage VA-E001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $0.00 | Q:60 /30Days | $11.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$88.00 |
$300* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $1.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R1390-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R1390-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$105.00 |
$480* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$8.00 | $0.00 | Q:30 /30Days | $10.42 |
Browse Plan Formulary all covered insulin pay $35 or less |