RYBELSUS 3 MG TABLET (30 TABLETS ) (NDC: 00169430330)
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 OR-0002 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC OR-0002 (PPO)](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 | $131.00 | P Q:30 /30Days | $978.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OR-0004 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC OR-0004 (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 | $131.00 | P Q:30 /30Days | $978.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OR-0004 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC OR-0004 (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 | $131.00 | P Q:30 /30Days | $977.56 |
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 | P Q:30 /30Days | $953.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit Elite Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare SmartFit 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 |
20% | 20% | P Q:30 /30Days | $953.02 |
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-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 | P Q:30 /30Days | $953.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
ATRIO Choice Rx (PPO)
![Email Prescription and/or Health Benefit details for ATRIO Choice Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $938.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days | $921.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Medicare (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days | $921.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Oregon (PPO)
![Email Prescription and/or Health Benefit details for Devoted CHOICE Oregon (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $117.50 | P Q:30 /30Days | $906.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Oregon (HMO)
![Email Prescription and/or Health Benefit details for Devoted CORE Oregon (HMO)](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 | $117.50 | P Q:30 /30Days | $906.53 |
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 |
Humana Gold Plus - Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $927.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-153 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-153 (HMO)](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 | $131.00 | Q:30 /30Days | $927.10 |
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. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $922.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Moda Health Elements PPORX (PPO)
![Email Prescription and/or Health Benefit details for Moda Health Elements PPORX (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $1,500.72 |
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. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $922.14 |
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. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $922.22 |
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 |
PacificSource Medicare MyCare Rx 40 (HMO)
![Email Prescription and/or Health Benefit details for PacificSource Medicare MyCare Rx 40 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $921.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Prime + Rx (HMO)
![Email Prescription and/or Health Benefit details for Providence Medicare Prime + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | P Q:1 /1Days | $945.32 |
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 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:30 /30Days | $952.40 |
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 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:30 /30Days | $939.37 |
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 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:30 /30Days | $961.03 |
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) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:30 /30Days | $952.40 |
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 |
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) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:30 /30Days | $944.42 |
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) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:30 /30Days | $961.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $792.04 |
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 |
$425 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $803.40 |
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 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $794.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $797.10 |
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 |
Devoted CHOICE PLUS Oregon (PPO)
![Email Prescription and/or Health Benefit details for Devoted CHOICE PLUS Oregon (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $112.50 | P Q:30 /30Days | $906.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Assist (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.60 |
$380 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $803.40 |
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) |
$20.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | P Q:30 /30Days | $953.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.70 |
$400 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | P Q:30 /30Days | $953.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care OR-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care OR-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P Q:30 /30Days | $978.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Low Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $792.04 |
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 OR-F002 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan OR-F002 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P Q:30 /30Days | $978.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Bridge + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Providence Medicare Bridge + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | P Q:1 /1Days | $944.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan OR-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan OR-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | P Q:30 /30Days | $978.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E002 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage RI-E002 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
3* |
Preferred Brand |
$47.00 | $131.00 | P Q:30 /30Days | $978.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-294 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-294 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
21% | 21% | Q:30 /30Days | $926.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OR-0001 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC OR-0001 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | P Q:30 /30Days | $978.31 |
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 |
Moda Health + Fred Meyer PPORX (PPO)
![Email Prescription and/or Health Benefit details for Moda Health + Fred Meyer PPORX (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $1,500.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeRight Advantage Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for AgeRight Advantage Health Plan (HMO I-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 |
25% | 25% | P Q:30 /30Days | $1,501.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
ATRIO Select Rx (PPO)
![Email Prescription and/or Health Benefit details for ATRIO Select Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $938.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
PacificSource Dual Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for PacificSource Dual Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.60 |
$545 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | P Q:30 /30Days | $922.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Dual Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Providence Medicare Dual Plus (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 |
3 |
Tier 3 |
15% | 15% | P Q:1 /1Days | $945.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage OR-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage OR-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 |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:30 /30Days | $978.26 |
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 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) |
$41.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $954.53 |
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) |
$41.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $939.37 |
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) |
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $951.42 |
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) |
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $944.23 |
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) |
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $961.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Extra Part B Only + Rx (HMO)
![Email Prescription and/or Health Benefit details for Providence Medicare Extra Part B Only + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$47.00 | $112.80 | P Q:1 /1Days | $945.59 |
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 |
AgeRight Advantage Plus Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for AgeRight Advantage Plus Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days | $1,501.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeRight Advantage Premier Health Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for AgeRight Advantage Premier Health Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | P Q:30 /30Days | $1,501.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OR-0003 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC OR-0003 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:30 /30Days | $978.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Choice + Rx (HMO-POS)
![Email Prescription and/or Health Benefit details for Providence Medicare Choice + Rx (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$71.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | P Q:1 /1Days | $944.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Moda Health Metro PPORX (PPO)
![Email Prescription and/or Health Benefit details for Moda Health Metro PPORX (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$86.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $1,500.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
ATRIO Prime Rx (PPO)
![Email Prescription and/or Health Benefit details for ATRIO Prime Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $938.75 |
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 |
Wellcare Premium Ultra Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare Premium Ultra Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$139.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $797.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Extra + Rx (HMO)
![Email Prescription and/or Health Benefit details for Providence Medicare Extra + Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | P Q:1 /1Days | $944.59 |
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) |
$166.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $952.40 |
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) |
$166.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | P Q:30 /30Days | $948.67 |
Browse Plan Formulary all covered insulin pay $35 or less |