SULFACETAMIDE 10% EYE DROPS [Sulf-10] (15 MLS ) (NDC: 24208067004)
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 IL-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC IL-0002 (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 | $20.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IL-001P (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC IL-001P (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 | $20.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC IL-0005 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage Walgreens from UHC IL-0005 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$195* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $24.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Better Health Premier Plan MMAI (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Aetna Better Health Premier Plan MMAI (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | None | $20.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | Q:90 /30Days | $20.75 |
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 |
Aetna Medicare Prime (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:90 /30Days | $20.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:90 /30Days | $20.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Basic (HMO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Basic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $29.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Basic Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Basic Plus (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 |
$8.00 | $16.00 | None | $29.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Classic (PPO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Classic (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $24.00 | None | $28.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Dental Premier (PPO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Dental Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $24.00 | None | $30.97 |
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 |
Blue Cross Medicare Advantage Elite (PPO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Elite (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$8.00 | $16.00 | None | $29.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Health Choice (PPO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Health Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $24.00 | None | $30.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Secure (HMO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Secure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $29.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Medicare Advantage (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Blue Medicare Advantage (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | None | $31.97 |
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 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$4.00 | $0.00 | None | $43.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Savings Medicare (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 |
$4.00 | $0.00 | None | $43.08 |
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 |
Cigna Premier Medicare (HMO-POS)
![Email Prescription and/or Health Benefit details for Cigna Premier Medicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$4.00 | $0.00 | None | $43.14 |
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 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$4.00 | $0.00 | None | $43.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Savings Medicare (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$4.00 | $0.00 | None | $43.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Community Advantage Plan (HMO)
![Email Prescription and/or Health Benefit details for Clear Spring Health Community Advantage Plan (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 |
$0.00 | $0.00 | None | $38.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Essential (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Clear Spring Health Essential (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $38.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clear Spring Health Essential (HMO)
![Email Prescription and/or Health Benefit details for Clear Spring Health Essential (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 |
$0.00 | $0.00 | None | $38.79 |
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 Illinois (PPO)
![Email Prescription and/or Health Benefit details for Devoted CHOICE Illinois (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$5.00 | $12.50 | None | $27.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Illinois (HMO)
![Email Prescription and/or Health Benefit details for Devoted CORE Illinois (HMO)](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 | $27.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted GIVEBACK Illinois (HMO)
![Email Prescription and/or Health Benefit details for Devoted GIVEBACK Illinois (HMO)](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 | $25.00 | None | $27.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Community HMO Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Community HMO Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $34.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-013 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1468-013 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | None | $34.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | None | $35.72 |
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 H5216-251 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-251 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | None | $34.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Meridian Medicare-Medicaid Plan (MMP) (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Meridian Medicare-Medicaid Plan (MMP) (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | None | $31.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Tier 1 |
0% | 0% | None | $27.48 |
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 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $24.00 | None | $27.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete - Giveback (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Complete - Giveback (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | None | $28.09 |
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 | None | $27.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO-POS)
![Email Prescription and/or Health Benefit details for Wellcare No Premium (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$5.00 | $0.00 | None | $19.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Essential (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Essential (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 |
$42.00 | $84.00 | None | $27.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Essential Value (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Essential Value (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 |
$42.00 | $84.00 | None | $27.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Exclusive (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Exclusive (HMO)](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 | $18.97 |
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 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $19.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Value (HMO-POS)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$5.00 | $0.00 | None | $19.11 |
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 |
Zing Elite Diabetes & Heart IL (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Zing Elite Diabetes & Heart IL (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 |
$5.00 | $0.00 | None | $12.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Select IL (HMO)
![Email Prescription and/or Health Benefit details for Zing Elite Select IL (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing ESRD Select IL (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Zing ESRD Select IL (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $0.00 | None | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Zing Essential Wellness Diabetes & Heart IL (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 |
$5.00 | $0.00 | None | $12.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
![Email Prescription and/or Health Benefit details for Zing Select Care IL (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $0.00 | None | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Zing Select Diabetes & Heart IL (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $0.00 | None | tbd |
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 Compass (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Assist Compass (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $30.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IL-F002 (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan IL-F002 (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $19.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$400* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | Q:90 /30Days | $20.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care IL-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care IL-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $20.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IL-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC IL-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $0.00 | None | $20.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-283 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | None | $34.80 |
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 IL-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan IL-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $20.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Longevity Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $36.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Provider Partners Illinois Advantage Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $14.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IL-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage IL-E001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $0.00 | None | $19.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Zing Select Diabetes & Heart Complete IL (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
25% | 0% | None | $12.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IL-0004 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC IL-0004 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $0.00 | None | $20.43 |
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 Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:90 /30Days | $20.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-006 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $0.00 | None | $37.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Premier Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Premier Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $29.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Choice Plus (PPO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Choice Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $29.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5361-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5361-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$97.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $0.00 | None | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-013 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$15.00 | $0.00 | None | $35.26 |
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 |
Blue Cross Medicare Advantage Choice Premier (PPO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Choice Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$135.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $16.00 | None | $29.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-357 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$138.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$15.00 | $0.00 | None | $34.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Enhanced Select (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Enhanced Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$169.00 |
$300* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $10.00 | Q:90 /30Days | $23.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Cross Medicare Advantage Flex (PPO)
![Email Prescription and/or Health Benefit details for Blue Cross Medicare Advantage Flex (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$202.00 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $24.00 | None | $30.97 |
Browse Plan Formulary all covered insulin pay $35 or less |