XIIDRA 5% EYE DROPS DROPERETTE (60 UNITS ) (NDC: 00078091112)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
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 |
AARP Medicare Advantage from UHC RI-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Explorer Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
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 Explorer Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Explorer Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Explorer Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Explorer Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Explorer Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days | $690.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days | $690.36 |
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 |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Preferred (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CCA Medicare Preferred (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Preferred (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Preferred (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Preferred (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Neighborhood INTEGRITY (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Neighborhood INTEGRITY (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $656.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Neighborhood INTEGRITY (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Neighborhood INTEGRITY (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $656.66 |
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 |
Neighborhood INTEGRITY (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Neighborhood INTEGRITY (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $656.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Neighborhood INTEGRITY (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Neighborhood INTEGRITY (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $656.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Neighborhood INTEGRITY (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Neighborhood INTEGRITY (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $656.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan EX-F005 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $708.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan EX-F005 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $708.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan EX-F005 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $708.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan EX-F005 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $708.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F005 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan EX-F005 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $708.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
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 |
AARP Medicare Advantage from UHC RI-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC RI-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days | $690.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
20% | 20% | Q:60 /30Days | $690.35 |
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 |
CCA Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Value (PPO)
![Email Prescription and/or Health Benefit details for CCA Medicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E002 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage RI-E002 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $708.52 |
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 |
UHC Care Advantage RI-E002 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage RI-E002 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $708.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan RI-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan RI-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan RI-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan RI-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan RI-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan RI-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $709.48 |
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 |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Maximum (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CCA Medicare Maximum (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CCA Medicare Maximum (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CCA Medicare Maximum (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Maximum (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CCA Medicare Maximum (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Maximum (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CCA Medicare Maximum (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Medicare Maximum (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CCA Medicare Maximum (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage RI-E001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage RI-E001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage RI-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage RI-E001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-S001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-S001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $709.48 |
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 |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete RI-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $709.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NG-0001 (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC NG-0001 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $709.24 |
Browse Plan Formulary all covered insulin pay $35 or less |