TRIKAFTA 100/50/75 MG-150 MG TABLET SEQ (units ) (NDC: 51167033101)
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 |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
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 Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
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 Freedom Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom Plan (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
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 Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
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 Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
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 Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Plus Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Sunrise Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Sunrise Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
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 Sunrise Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Sunrise Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Sunrise Plan (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Sunrise Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Sunrise Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Sunrise Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
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 Sunrise Plan (HMO-POS)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health AVA (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health AVA (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health AVA (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $25,689.47 |
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 |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE + Walgreens (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE + Walgreens (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $27,030.36 |
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 |
Alignment Health the ONE + Walgreens (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $27,030.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Prime (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Prime (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Prime (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,570.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Prime (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,570.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Prime (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,570.15 |
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 |
Blue Best Life Classic (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,739.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Classic (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,739.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Classic (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,388.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Achieve Medicare (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Achieve Medicare (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Achieve Medicare (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
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 Alliance Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Alliance Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Alliance Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
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, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
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 Savings Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,182.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted BE WELL Arizona (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted BE WELL Arizona (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$175 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$175 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$200 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$200 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$200 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$200 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$200 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $27,239.73 |
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 Arizona (PPO)
|
$0.00 |
$200 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Arizona (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE GIVEBACK Arizona (PPO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE GIVEBACK Arizona (PPO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE GIVEBACK Arizona (PPO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE GIVEBACK Arizona (PPO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $27,239.73 |
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 GIVEBACK Arizona (PPO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE GIVEBACK Arizona (PPO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Arizona (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Arizona (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Arizona (HMO)
|
$0.00 |
$225 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Arizona (HMO)
|
$0.00 |
$225 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $27,239.73 |
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 CORE Arizona (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted GIVEBACK Arizona (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,239.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted GIVEBACK Arizona (HMO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted GIVEBACK Arizona (HMO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
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 |
Dialysis Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Grand Give Back (HMO)
|
$0.00 |
$185 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $25,914.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gold Circle (HMO-POS C-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gold Circle (HMO-POS C-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gold Circle (HMO-POS C-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
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 |
Gold Circle (HMO-POS C-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-021 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
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 H0028-021 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-024 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-024 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-027 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-028 (HMO)
|
$0.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-028 (HMO)
|
$0.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
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 H0028-052 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-052 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-052 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-062 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H2463-001 (HMO)
|
$0.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H2463-001 (HMO)
|
$0.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $26,646.95 |
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 USAA Honor with Rx (PPO)
|
$0.00 |
$480 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$480 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$480 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
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 H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
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 H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
|
$0.00 |
$500 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $26,007.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-260 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-260 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-260 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
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 H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
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 H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
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 H5216-265 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-265 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-265 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-371 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-371 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-371 (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Balance (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Balance (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Balance (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
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 |
SCAN Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Embrace (HMO-POS I-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Embrace (HMO-POS I-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Heart First (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
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 |
SCAN Heart First (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Heart First (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Venture (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Venture (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Venture (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
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 |
Super Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
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 | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
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 | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
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)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
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)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
28% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
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 |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Specialty No Premium (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,808.28 |
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 Chronic Care (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Chronic Care 2 (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint I Carelon Home Care (HMO I-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,126.19 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint I Carelon Home Care (HMO I-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,115.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint I Carelon Home Care 2 (HMO I-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,115.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint I Carelon Home Care 2 (HMO I-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,115.48 |
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 I Carelon Kidney Care (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Lung Care (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Lung Care 2 (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage 1 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage 2 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Premium Savings (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,137.60 |
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 |
Alignment Health Heart & Diabetes Plus (HMO C-SNP)
|
$6.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes Plus (HMO C-SNP)
|
$6.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes Plus (HMO C-SNP)
|
$6.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:90 /30Days | $25,689.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PREMIUM Arizona (HMO)
|
$11.40 |
$150 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PREMIUM Arizona (HMO)
|
$11.40 |
$150 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
30% | n/a | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$12.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Complete Care (HMO D-SNP)
|
$12.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$12.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
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)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.00 |
$525 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $25,808.28 |
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)
|
$16.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value Plus Plan (HMO-POS)
|
$19.70 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$19.80 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$19.80 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
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 Plus Plan (HMO-POS)
|
$19.80 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Plus (PPO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Plus (PPO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,545.64 |
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 |
Banner Medicare Advantage Plus (PPO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,570.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Plus (PPO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,570.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Plus (PPO)
|
$20.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,570.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted BE WELL PLUS Arizona (HMO C-SNP)
|
$20.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted BE WELL PLUS Arizona (HMO C-SNP)
|
$20.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$22.70 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
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 Plus Plan (HMO-POS)
|
$23.80 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$23.80 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$23.80 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$23.80 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$25.00 |
$400 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
27% | n/a | P Q:84 /28Days | $28,040.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Complete (HMO-POS C-SNP)
|
$25.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
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 |
Super Complete (HMO-POS C-SNP)
|
$25.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Complete (HMO-POS C-SNP)
|
$25.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Complete (HMO-POS C-SNP)
|
$25.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$27.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$28.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $25,868.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$28.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $25,868.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$28.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $25,868.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$28.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $25,868.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$28.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $25,868.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SCAN Strive (HMO C-SNP)
|
$34.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
SCAN Strive (HMO C-SNP)
|
$34.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P | $26,754.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
|
$35.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
|
$35.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
|
$35.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
|
$35.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
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 H5216-224 (PPO)
|
$35.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-023 (HMO)
|
$37.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-023 (HMO)
|
$37.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-023 (HMO)
|
$37.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
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 H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
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 H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
|
$37.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $26,646.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Complete (HMO-POS C-SNP)
|
$37.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Complete (HMO-POS C-SNP)
|
$37.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
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 |
Dialysis Complete (HMO-POS C-SNP)
|
$37.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Complete (HMO-POS C-SNP)
|
$37.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | P Q:84 /28Days | $25,404.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
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 |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
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 |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
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 |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Banner Medicare Advantage Dual (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:84 /28Days | $24,545.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCBSAZ Health Choice Pathway (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
eternalHealth Horizon (HMO)
|
$43.20 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,914.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy Care Advantage (HMO D-SNP)
|
$43.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:84 /28Days | $26,917.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Plus (HMO)
|
$45.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,739.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Plus (HMO)
|
$45.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,739.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueJourney (PPO)
|
$60.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $25,739.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueJourney (PPO)
|
$60.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,388.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
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 Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
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 Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essentials Plan (PPO)
|
$73.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $27,076.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R7220-002 (Regional PPO)
|
$75.00 |
$540 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
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 H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
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 H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
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 H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
|
$107.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
|
$125.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
|
$125.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
|
$125.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
|
$125.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
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 H5216-034 (PPO)
|
$125.00 |
$225 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
29% | n/a | P Q:84 /28Days | $24,953.24 |
Browse Plan Formulary all covered insulin pay $35 or less |