ADEMPAS 2.5 MG TABLET (90 EA ) (NDC: 50419025401)
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 HI-0001 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $16,102.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE GIVEBACK Hawaii (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE GIVEBACK Hawaii (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Hawaii (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Hawaii (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:90 /30Days | $14,077.38 |
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 |
HMSA Akamai Advantage Complete (PPO)
|
$0.00 |
$380 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | 27% | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard (PPO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | 27% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard (PPO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | 27% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard (PPO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | 27% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard (PPO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | 27% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-048 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H0028-048 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-048 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-048 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-048 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-048 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:90 /30Days | $13,512.87 |
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 H5216-233 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-233 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-233 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-233 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-233 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-233 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare 'Ohana No Premium (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $13,319.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana No Premium (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $13,319.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana No Premium Open (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $13,319.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE PLUS Hawaii (PPO)
|
$5.80 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE PLUS Hawaii (PPO)
|
$5.80 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Assist Open (PPO)
|
$11.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:90 /30Days | $13,319.50 |
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 HI-0003 (PPO)
|
$17.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $14,887.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC HI-0003 (PPO)
|
$17.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $14,887.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-313 (PPO)
|
$23.00 |
$160 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-313 (PPO)
|
$23.00 |
$160 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-313 (PPO)
|
$23.00 |
$160 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Dual Liberty (HMO D-SNP)
|
$27.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare 'Ohana Dual Liberty (HMO D-SNP)
|
$27.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Dual Liberty (HMO D-SNP)
|
$27.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Dual Liberty (HMO D-SNP)
|
$27.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Basic (HMO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P | $14,042.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Low Premium Open (PPO)
|
$33.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:90 /30Days | $13,319.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Low Premium Open (PPO)
|
$33.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:90 /30Days | $13,319.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare 'Ohana Low Premium Open (PPO)
|
$33.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:90 /30Days | $13,319.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC HI-0004 (PPO)
|
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $14,887.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Dual Align (HMO D-SNP)
|
$38.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Dual Align (HMO D-SNP)
|
$38.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Dual Align (HMO D-SNP)
|
$38.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare 'Ohana Dual Align (HMO D-SNP)
|
$38.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $13,329.30 |
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 |
AlohaCare Advantage (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage Plus (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
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 |
AlohaCare Advantage Plus (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage Plus (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage Plus (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
AlohaCare Advantage Plus (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $13,778.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Dual Care (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Dual Care (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $14,077.38 |
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 |
HMSA Akamai Advantage Dual Care (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Dual Care (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Dual Care (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Advantage Medicare Medicaid (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $14,042.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Advantage Medicare Medicaid (HMO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $14,042.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete HI-S001 (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $16,102.67 |
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 HI-S001 (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $16,102.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete HI-S001 (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $16,102.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete HI-S001 (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $16,102.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete HI-S001 (PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $16,102.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete HI-S002 (Regional PPO D-SNP)
|
$40.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $16,102.67 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC HI-0002 (PPO)
|
$44.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $16,102.67 |
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 H5216-232 (PPO)
|
$50.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-232 (PPO)
|
$50.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-232 (PPO)
|
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-232 (PPO)
|
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-232 (PPO)
|
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,512.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-232 (PPO)
|
$58.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:90 /30Days | $13,886.50 |
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 |
HMSA Akamai Advantage Complete Plus (PPO)
|
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P Q:90 /30Days | $14,077.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard Plus (PPO)
|
$130.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard Plus (PPO)
|
$130.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard Plus (PPO)
|
$130.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
HMSA Akamai Advantage Standard Plus (PPO)
|
$130.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P Q:90 /30Days | $14,253.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Enhanced (HMO)
|
$139.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P | $14,042.11 |
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 |
Kaiser Permanente Senior Advantage Maui (HMO)
|
$166.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P | $14,154.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Hawaii Island (HMO)
|
$191.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 33% | P | $14,154.97 |
Browse Plan Formulary all covered insulin pay $35 or less |