ESOMEPRAZOLE MAG DR 20 MG CAPSULE DR [Nexium 24HR Clear Minis] (30 UNITS ) (NDC: 43598050930)
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 VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
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 VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
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 VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
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 VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
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 VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | 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 |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $10.77 |
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 |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $10.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $10.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $10.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $10.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $10.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
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 |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
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 |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, but No Gap Coverage for this drug. | 2* |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 | 2 |
Generic |
$5.00 | $0.00 | None | $6.53 |
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 Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
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 Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
46% | 46% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
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 Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
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 Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
47% | 47% | None | $100.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
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 VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
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 VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.75 |
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 VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
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 VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
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 VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:90 /30Days | $12.75 |
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. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days | $12.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
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 |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
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 |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $25.00 | Q:60 /30Days | $14.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | 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 |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $11.23 |
Browse Plan Formulary all covered insulin pay $35 or less |