OLMESARTAN MEDOXOMIL 5 MG TABLET [Benicar] (30 TABLETS ) (NDC: 68462043630)
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 EP-0001 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $1.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC EP-0002 (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $1.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC EP-0003 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $1.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC TX-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $1.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice Plan (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $0.49 |
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 Value Plan (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health AVA (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Tier 6 |
$5.00 | $0.00 | Q:60 /30Days | $9.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO-POS C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Tier 6 |
$5.00 | $0.00 | Q:60 /30Days | $11.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO-POS)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
6* |
Tier 6 |
$5.00 | $0.00 | Q:60 /30Days | $11.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE + Walgreens (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Tier 6 |
$5.00 | $0.00 | Q:60 /30Days | $11.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Basic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $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 |
Blue Cross Medicare Advantage Choice Plus (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Complete (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $9.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Dental Premier (PPO)
|
$0.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $9.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Health Choice (PPO)
|
$0.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $9.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Saver (HMO)
|
$0.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $8.18 |
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 |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.49 |
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, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE El Paso (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $48.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted GIVEBACK El Paso (HMO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $48.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-035 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-350 (PPO)
|
$0.00 |
$400* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-353 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | Q:60 /30Days | $24.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | Q:60 /30Days | $24.83 |
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 |
1 |
Preferred Generic |
$3.00 | $6.00 | Q:60 /30Days | $27.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care Select (HMO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$15.00 | $30.00 | Q:60 /30Days | $27.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care TX-0017 (HMO-POS C-SNP)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $1.42 |
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 (HMO)
|
$0.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $2.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $2.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$200* |
Yes, this drug has Gap Coverage. |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $2.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Rx Plus Open (PPO)
|
$0.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $1.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage 2 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
6 |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $1.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care TX-001A (Regional PPO C-SNP)
|
$10.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:60 /30Days | $1.83 |
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 TotalCare (HMO D-SNP)
|
$11.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $5.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$11.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $5.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$11.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $5.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$11.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $4.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$11.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $5.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete TX-V004 (HMO-POS D-SNP)
|
$11.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $1.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Dual Complete TX-D001 (PPO D-SNP)
|
$12.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $1.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP)
|
$14.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
25% | 25% | Q:60 /30Days | $11.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-043 (PPO)
|
$16.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-043 (PPO)
|
$16.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-043 (PPO)
|
$16.00 |
$0 |
Yes, this drug has Gap Coverage. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $5.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$19.40 |
$100* |
Yes, this drug has Gap Coverage. |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $0.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complement Assist (HMO)
|
$21.10 |
$505* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $5.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Dual Advantage 2 (HMO D-SNP)
|
$21.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
15% | 15% | Q:60 /30Days | $1.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
|
$21.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $8.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Harmony (HMO D-SNP)
|
$21.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $6.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care TX-0029 (Regional PPO C-SNP)
|
$22.00 |
$295* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:60 /30Days | $1.83 |
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)
|
$22.40 |
$535* |
No additional gap coverage, only the Donut Hole Discount |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $4.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty Nurture (HMO D-SNP)
|
$22.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $6.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage 2 (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $1.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$26.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $5.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$27.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $5.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Complete Plan (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $3.12 |
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 |
El Paso Health Medicare Advantage Dual (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $11.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $2.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H0028-034 (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $2.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H0028-064 (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $2.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $27.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Texas Advantage Plan (HMO I-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $8.15 |
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 |
UHC Dual Complete TX-S001 (Regional PPO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $1.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:60 /30Days | $5.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
15% | 15% | Q:60 /30Days | $1.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
15% | 15% | Q:60 /30Days | $1.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
15% | 15% | Q:60 /30Days | $1.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
15% | 15% | Q:60 /30Days | $1.10 |
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 |
Wellpoint Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
15% | 15% | Q:60 /30Days | $1.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $1.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $1.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $1.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$28.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
6 |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days | $1.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-084 (PFFS)
|
$45.00 |
$250* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$6.00 | $0.00 | Q:60 /30Days | $2.57 |
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 |
UHC Medicare Advantage TX-0030 (Regional PPO)
|
$48.00 |
$395* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$4.00 | $0.00 | Q:60 /30Days | $1.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R4182-004 (Regional PPO)
|
$49.00 |
$275* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$6.00 | $0.00 | Q:60 /30Days | $2.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R4182-003 (Regional PPO)
|
$72.00 |
$175* |
Yes, this drug has Gap Coverage. |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $2.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Flex (PPO)
|
$238.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days | $9.19 |
Browse Plan Formulary all covered insulin pay $35 or less |