HUMIRA 40 MG/0.8 ML PEN (2 EA ) (NDC: 00074433902)
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 OH-0004 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,094.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,094.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,417.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,094.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0017 (HMO-POS)
|
$0.00 |
$395 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,218.68 |
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 Advantra Silver (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,812.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,812.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:6 /28Days | $6,811.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,812.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,791.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,803.61 |
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 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,802.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,790.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Tier 2 |
0% | 0% | P Q:6 /28Days | $6,314.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareSource MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Tier 2 |
0% | 0% | P Q:4 /28Days | $6,315.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,338.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,338.75 |
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 |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,338.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Ohio (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Ohio (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted GIVEBACK Ohio (HMO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Cleveland Clinic Preferred (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,594.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$200 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
30% | n/a | P Q:6 /28Days | $6,610.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H6622-022 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,606.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:6 /28Days | $6,629.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-285 (PPO)
|
$0.00 |
$200 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:6 /28Days | $6,607.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:6 /28Days | $6,628.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Access (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,357.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Access (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,456.33 |
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 |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,317.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,401.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,461.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$100 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,362.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$100 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,485.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Choice Care Select (HMO)
|
$0.00 |
$375 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
27% | n/a | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
PARAMOUNT ELITE NE OHIO STANDARD (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:6 /28Days | $6,595.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Paramount Elite Preferred (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,595.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
PrimeTime Health Plan Aultimate (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $6,759.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
SummaCare Medicare Topaz (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,700.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureCare - Option II (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,358.65 |
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 |
The Health Plan SecureChoice Optimum (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,363.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureChoice Optimum (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,235.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Tier 2 |
0% | 0% | P Q:2 /28Days | $6,960.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dividend Giveback (HMO)
|
$0.00 |
$330 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
28% | n/a | P Q:6 /28Days | $6,381.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$275 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $6,412.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$75 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $6,412.44 |
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 No Premium Essential (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,308.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
28% | n/a | P Q:6 /28Days | $6,412.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PRIME Ohio (HMO)
|
$14.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$17.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | P Q:6 /28Days | $6,412.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$18.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:6 /28Days | $6,607.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Extra Help (HMO)
|
$19.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:4 /28Days | $6,801.08 |
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 |
SummaCare Medicare Jade with Bene-FlexTM (HMO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,700.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
SummaCare Medicare Jade with Bene-FlexTM (HMO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,709.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$20.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$21.40 |
$535 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:6 /28Days | $6,412.44 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-106 (PPO)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,599.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Secure (HMO)
|
$22.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,317.61 |
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 |
MedMutual Advantage Secure (HMO)
|
$22.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,461.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0006 (HMO-POS)
|
$24.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,094.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0006 (HMO-POS)
|
$24.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,417.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 2 (HMO)
|
$25.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,801.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$26.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:4 /28Days | $6,804.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$26.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:6 /28Days | $6,410.58 |
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)
|
$27.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted DUAL PLUS Ohio (HMO D-SNP)
|
$28.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0008 (HMO-POS)
|
$29.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,094.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0008 (HMO-POS)
|
$29.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,417.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$29.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,338.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Extra (HMO-POS D-SNP)
|
$29.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:6 /28Days | $6,381.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-042 (PPO)
|
$30.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:6 /28Days | $6,607.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
SummaCare Medicare Garnet (HMO)
|
$30.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,737.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
SummaCare Medicare Garnet (HMO)
|
$30.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,693.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted DUAL Ohio (HMO D-SNP)
|
$30.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:6 /28Days | $6,479.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$34.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:4 /28Days | $6,395.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure 1 (HMO D-SNP)
|
$36.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:6 /28Days | $6,811.97 |
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 Value Plus H5525-041 (PPO)
|
$37.10 |
$260 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $6,607.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:6 /28Days | $6,412.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$38.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $6,395.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$38.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $6,804.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
PrimeTime Health Plan Classic (HMO-POS)
|
$39.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $6,759.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Choice (HMO)
|
$40.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,317.61 |
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 |
MedMutual Advantage Choice (HMO)
|
$40.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,401.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Choice (HMO)
|
$40.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,461.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureCare SNP (HMO D-SNP)
|
$40.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | P Q:4 /28Days | $6,334.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareSource Dual Advantage (HMO D-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $6,438.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:6 /28Days | $6,610.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:6 /28Days | $6,610.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5525-046 (PPO D-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:6 /28Days | $6,607.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete OH-D002 (HMO-POS D-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,404.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete OH-S001 (PPO D-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,218.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete OH-V002 (HMO-POS D-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,404.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan OH-F001 (PPO I-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,208.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Valor Health Plan (HMO I-SNP)
|
$40.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | P | $7,162.06 |
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 H5216-024 (PPO)
|
$41.00 |
$100 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $6,598.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Select (PPO)
|
$44.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,317.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Select (PPO)
|
$44.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,401.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Select (PPO)
|
$44.00 |
$95 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,461.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $6,801.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
SummaCare Medicare Ruby (HMO)
|
$50.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,701.09 |
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 R5495-002 (Regional PPO)
|
$51.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:6 /28Days | $6,607.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
PARAMOUNT ELITE NE OHIO PRIME (HMO-POS)
|
$62.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:6 /28Days | $6,595.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (Regional PPO)
|
$73.00 |
$50 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,801.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-019 (HMO)
|
$73.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $6,610.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Preferred (PPO)
|
$73.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,317.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Preferred (PPO)
|
$73.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,401.86 |
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 |
MedMutual Advantage Preferred (PPO)
|
$73.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,461.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
SummaCare Medicare Sapphire (HMO-POS)
|
$79.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,699.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
PrimeTime Health Plan Plus (HMO-POS)
|
$89.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:4 /30Days | $6,759.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Plus (HMO)
|
$90.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,317.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Plus (HMO)
|
$90.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,401.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Plus (HMO)
|
$90.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,461.40 |
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 2 (PPO)
|
$92.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,811.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureChoice - Option II (PPO)
|
$93.40 |
$100 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | P Q:4 /28Days | $6,358.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OH-0001 (HMO-POS)
|
$104.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,223.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier 1 (PPO)
|
$110.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,811.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-030 (PPO)
|
$115.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $6,607.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Premium (PPO)
|
$127.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,317.61 |
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 |
MedMutual Advantage Premium (PPO)
|
$127.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,401.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Premium (PPO)
|
$127.00 |
$55 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
32% | n/a | P Q:4 /28Days | $6,461.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plus 2 (Regional PPO)
|
$149.00 |
$250 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $6,811.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
SummaCare Medicare Emerald (HMO-POS)
|
$169.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $6,700.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plus 1 (Regional PPO)
|
$208.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $6,811.97 |
Browse Plan Formulary all covered insulin pay $35 or less |