DEPO-ESTRADIOL 5MG/ML VIAL (5 ML VIAL) (NDC: 00009027101)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
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 ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
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 ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
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 ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
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 ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
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 |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
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 |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $70.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-001 (HMO)
|
$0.00 |
$450 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $176.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-001 (HMO)
|
$0.00 |
$450 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $176.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-001 (HMO)
|
$0.00 |
$450 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $176.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-001 (HMO)
|
$0.00 |
$450 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $176.24 |
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 H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
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 H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
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 H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-066 (HMO)
|
$0.00 |
$355 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
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)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
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)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
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)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
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 H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
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 H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-175 (PPO)
|
$0.00 |
$250* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
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 Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
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 Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
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 Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
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 |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
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 |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $191.21 |
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 |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $141.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
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 |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
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 |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
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 |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $182.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
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 |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
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 |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
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 |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | None | $182.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $187.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $187.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $187.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $187.99 |
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-F003 (PPO I-SNP)
|
$33.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $187.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $187.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $187.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-137 (HMO)
|
$34.00 |
$400* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-137 (HMO)
|
$34.00 |
$400* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-137 (HMO)
|
$34.00 |
$400* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.23 |
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 H5619-137 (HMO)
|
$34.00 |
$400* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-137 (HMO)
|
$34.00 |
$400* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-137 (HMO)
|
$34.00 |
$400* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
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 SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
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 SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
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 SNP-DE H5619-003 (HMO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
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 SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
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 SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
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 ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
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 ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
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 ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
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 ME-S003 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $196.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$42.00 | $84.00 | None | $191.21 |
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 H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
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 H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
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 H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-177 (PPO)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days | $175.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
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 ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
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 ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $186.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MH-0001 (Regional PPO)
|
$58.00 |
$295 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $187.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $74.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $74.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $74.00 | None | $191.21 |
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 |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $74.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$37.00 | $74.00 | None | $191.21 |
Browse Plan Formulary all covered insulin pay $35 or less |