XTAMPZA ER 18 MG CAPSULE (NDC: 24510012010)
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 VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-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:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-058 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
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 H5216-058 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-058 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-058 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-058 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-058 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-058 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-138 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $678.69 |
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 H5216-138 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-138 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $678.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-138 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $678.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-138 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $678.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-138 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $678.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-138 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $678.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
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 |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
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 |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Unity HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $118.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VT-0001 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Medicare Advantage VT-001A (PPO)
![Email Prescription and/or Health Benefit details for UHC Medicare Advantage VT-001A (PPO)](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 |
25% | 25% | Q:90 /30Days | $721.12 |
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:90 /30Days | $722.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
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 |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
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 |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
![Email Prescription and/or Health Benefit details for Vermont Blue Advantage Freedom Plus PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$59.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $686.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-057 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-057 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
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 H5216-057 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-057 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-057 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-057 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-057 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $677.56 |
Browse Plan Formulary all covered insulin pay $35 or less |