RISPERIDONE ER 37.5 MG VIAL [Rykindo] (ML ) (NDC: 00480134208)
2024 Medicare Prescription Drug Plan (MAPD) Information
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Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Additional Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC MI-0008 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $783.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
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 |
BCN Advantage HMO-POS Prime Value (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $769.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue + Meijer (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue + Meijer (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue + Meijer (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue + Meijer (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
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 |
Medicare Plus Blue + Meijer (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
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 |
Medicare Plus Blue PPO Part B Credit (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
27% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Part B Credit (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
27% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Part B Credit (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
27% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Part B Credit (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
27% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Part B Credit (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
27% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | Q:2 /28Days | $747.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Choice Care Select (HMO)
|
$0.00 |
$375 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
27% | n/a | Q:2 /28Days | $747.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Edge (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Edge (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Edge (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
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 |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Vital (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
26% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Vital (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
26% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Vital (PPO)
|
$0.00 |
$350 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
26% | n/a | Q:2 /28Days | $586.71 |
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 |
PriorityMedicare Ideal (PPO)
|
$19.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
30% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$19.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
30% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$19.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
30% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$19.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
30% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Ideal (PPO)
|
$19.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
30% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$21.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:2 /28Days | $747.05 |
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 |
McLaren Medicare Inspire Plus (HMO)
|
$25.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $769.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$27.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | Q:2 /28Days | $747.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MI-0009 (PPO)
|
$28.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $783.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$31.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$31.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$31.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | Q:2 /28Days | $586.71 |
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 |
PriorityMedicare Value (HMO-POS)
|
$31.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Value (HMO-POS)
|
$31.00 |
$75 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
31% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Duals (HMO D-SNP)
|
$35.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | Q:2 /28Days | $769.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare D-SNP (HMO D-SNP)
|
$35.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
$0.00 | $0.00 | Q:2 /28Days | $595.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MI-S001 (PPO D-SNP)
|
$35.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $783.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MI-S002 (HMO-POS D-SNP)
|
$35.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | None | $783.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Dual Complete MI-V001 (HMO-POS D-SNP)
|
$35.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $783.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Flex (HMO-POS)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $769.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
McLaren Medicare Inspire Flex (HMO-POS)
|
$49.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $769.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$73.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$73.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$73.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
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 |
PriorityMedicare Merit (PPO)
|
$73.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Merit (PPO)
|
$73.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$78.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$79.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$79.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$79.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$79.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare (HMO-POS)
|
$79.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$102.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Signature (PPO)
|
$120.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
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 |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
PriorityMedicare Select (PPO)
|
$147.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
33% | n/a | Q:2 /28Days | $586.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$216.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$216.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$216.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$216.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare Plus Blue PPO Assure (PPO)
|
$216.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $762.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$226.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Tier 5 |
33% | n/a | S Q:2 /28Days | $791.02 |
Browse Plan Formulary all covered insulin pay $35 or less |