NORTRIPTYLINE HCL 75 MG CAPSULE [Pamelor] (30 CAPSULES ) (NDC: 51672400401)
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 WA-0006 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC WA-0006 (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 |
$12.00 | $0.00 | None | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WA-0007 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC WA-0007 (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 |
$10.00 | $0.00 | None | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Elite Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Extra Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Extra Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Preferred Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Preferred Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.13 |
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 |
Aetna Medicare Prime Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare SmartFit Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | None | $10.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Health Plan of WA MA Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for Community Health Plan of WA MA Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$230* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $20.00 | None | $11.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-100 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-100 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-247 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-247 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.57 |
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 |
Kaiser Permanente Medicare Advantage Key (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Medicare Advantage Key (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$7.00 | $0.00 | P | $5.61 |
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 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | None | $6.91 |
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 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | None | $6.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
PacificSource Medicare Explorer Rx 11 (PPO)
![Email Prescription and/or Health Benefit details for PacificSource Medicare Explorer Rx 11 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$4.00 | $8.00 | None | $6.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)
![Email Prescription and/or Health Benefit details for PacificSource Medicare MyCare Choice Rx 34 (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 |
$0.00 | $0.00 | None | $6.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premera Blue Cross Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Premera Blue Cross Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $36.00 | None | $4.06 |
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 |
Regence BlueAdvantage HMO (HMO)
![Email Prescription and/or Health Benefit details for Regence BlueAdvantage HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $0.00 | None | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence BlueAdvantage HMO (HMO)
![Email Prescription and/or Health Benefit details for Regence BlueAdvantage HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $0.00 | None | $7.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$440* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Mutual of Omaha No Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Mutual of Omaha No Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | None | $7.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$4.00 | $0.00 | None | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Wellpoint Kidney Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $0.00 | None | $4.18 |
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 (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Assist (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $0.00 | None | $17.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $14.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Liberty (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $14.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WA-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC WA-0003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | None | $9.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Mutual of Omaha Low Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Mutual of Omaha Low Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$5.00 | $0.00 | None | $7.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellpoint Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $3.10 |
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 Nursing Home Plan WA-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan WA-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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) |
$33.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $6.91 |
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) |
$33.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $6.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5619-134 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-134 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $6.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Medicare Advantage Vital (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Medicare Advantage Vital (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $0.00 | P | $5.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $6.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $7.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $6.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $6.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access Open (PPO 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 | $14.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Health Plan of WA MA Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for Community Health Plan of WA MA Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | None | $11.70 |
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) |
$39.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $8.87 |
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 |
Community Health Plan of WA Dual Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Community Health Plan of WA Dual Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $11.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Health Plan of WA Dual Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Community Health Plan of WA Dual Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $11.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WA-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage WA-E001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $0.00 | None | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WA-D001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete WA-D001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $9.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WA-D002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete WA-D002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $9.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WA-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete WA-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $9.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WA-0005 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC WA-0005 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | None | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Primary (PPO)
![Email Prescription and/or Health Benefit details for Regence MedAdvantage + Rx Primary (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $7.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Primary (PPO)
![Email Prescription and/or Health Benefit details for Regence MedAdvantage + Rx Primary (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $11.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Primary (PPO)
![Email Prescription and/or Health Benefit details for Regence MedAdvantage + Rx Primary (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $0.00 | None | $10.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plus Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Platinum Plus Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence BlueAdvantage HMO Plus (HMO)
![Email Prescription and/or Health Benefit details for Regence BlueAdvantage HMO Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $24.00 | None | $8.64 |
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 |
Premera Blue Cross Medicare Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for Premera Blue Cross Medicare Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $30.00 | None | $4.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-061 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-061 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Health Plan of WA MA Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for Community Health Plan of WA MA Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$10.00 | $20.00 | None | $11.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Classic (PPO)
![Email Prescription and/or Health Benefit details for Regence MedAdvantage + Rx Classic (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$82.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$13.00 | $26.00 | None | $9.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WA-0010 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC WA-0010 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$84.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$12.00 | $0.00 | None | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Select Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$89.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.08 |
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 |
Kaiser Permanente Medicare Advantage Essential (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Medicare Advantage Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$94.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $0.00 | P | $5.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for Regence MedAdvantage + Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$147.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $16.00 | None | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-048 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-048 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$200.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $6.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Medicare Advantage Optimal (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Medicare Advantage Optimal (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$327.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $0.00 | P | $5.61 |
Browse Plan Formulary all covered insulin pay $35 or less |