PENTASA 250MG CAPSULE SA (240 BOT) (NDC: 54092018981)
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 FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
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 |
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0005 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
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 FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
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 FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0007 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0007 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0007 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
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 FL-0007 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0008 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0008 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0008 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0008 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0008 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
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 FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
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 FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0009 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
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 |
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0010 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
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 |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
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 |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0011 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0012 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
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 FL-0012 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0012 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0013 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,481.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0013 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,481.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0013 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,481.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0015 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,469.14 |
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 FL-0016 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0016 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0016 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0016 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0016 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,464.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0017 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
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 |
AARP Medicare Advantage from UHC FL-0017 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0017 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0017 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0017 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0017 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0017 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.30 |
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 |
AARP Medicare Advantage from UHC FL-0018 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0018 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0018 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0018 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0019 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0019 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.02 |
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 |
AARP Medicare Advantage from UHC FL-0019 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0019 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0019 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,478.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-001P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-001P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-001P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
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 FL-001P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
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 |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
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 |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0020 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,471.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0021 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0021 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0021 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0021 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,475.71 |
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 |
AARP Medicare Advantage from UHC FL-0021 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0021 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0021 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,475.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
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 FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
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 FL-0022 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0023 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0023 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0024 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,469.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0024 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,469.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0024 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,469.42 |
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 FL-0025 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0025 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0025 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0025 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0026 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,468.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0026 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,468.75 |
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 |
AARP Medicare Advantage from UHC FL-0026 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,468.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0027 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0027 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0027 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0031 (Regional PPO)
|
$0.00 |
$395 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-003P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.68 |
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 FL-003P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-003P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-003P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,477.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$55.00 | $110.00 | None | $1,445.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$55.00 | $110.00 | None | $1,445.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,435.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,435.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,435.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$70.00 | $140.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$70.00 | $140.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$65.00 | $130.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$70.00 | $140.00 | None | $1,444.70 |
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 |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$70.00 | $140.00 | None | $1,444.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care CHF by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care CHF by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care CHF by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
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 |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
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 |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,443.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.33 |
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 |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$50.00 | $100.00 | None | $1,445.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Heart & Diabetes (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
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 |
Alignment Health Platinum (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,440.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Platinum (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,440.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Platinum + Walgreens (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,449.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health Platinum + Walgreens (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,449.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO-POS)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO-POS)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
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 |
Alignment Health smartHMO (HMO-POS)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health smartHMO (HMO-POS)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE (HMO D-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
37% | 37% | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE (HMO D-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
37% | 37% | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE (HMO D-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
37% | 37% | Q:480 /30Days | $1,443.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Alignment Health the ONE (HMO D-SNP)
|
$0.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
37% | 37% | Q:480 /30Days | $1,443.74 |
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 |
AvMed Medicare Access (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$75.00 | $187.50 | None | $1,358.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Access (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$75.00 | $187.50 | None | $1,351.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$35.00 | $87.50 | None | $1,358.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$65.00 | $162.50 | None | $1,351.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Circle (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$35.00 | $87.50 | None | $1,358.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Circle (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$65.00 | $162.50 | None | $1,351.20 |
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 |
AvMed Medicare One (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$75.00 | $187.50 | None | $1,330.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare One (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | $212.50 | None | $1,368.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare One (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | $212.50 | None | $1,368.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare One (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | $212.50 | None | $1,368.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare One (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$35.00 | $87.50 | None | $1,358.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare One (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$65.00 | $162.50 | None | $1,351.20 |
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 |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,400.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,423.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
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 |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
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 |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
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 |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,441.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,406.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,406.64 |
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 |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,406.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,458.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,458.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,458.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,458.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,454.11 |
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 |
BlueMedicare Classic Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,438.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,438.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,438.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,438.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,438.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Preferred (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$80.00 | $240.00 | Q:480 /30Days | $1,460.54 |
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 |
BlueMedicare Preferred (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$80.00 | $240.00 | Q:480 /30Days | $1,460.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,423.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$80.00 | $240.00 | Q:480 /30Days | $1,460.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$80.00 | $240.00 | Q:480 /30Days | $1,460.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$50.00 | $150.00 | Q:480 /30Days | $1,400.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,438.13 |
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 |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,406.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,406.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,406.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,447.68 |
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 |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,447.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,447.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,427.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,427.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,427.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,448.93 |
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 |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,448.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,448.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,448.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $270.00 | Q:480 /30Days | $1,448.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,434.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,434.53 |
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 |
Erickson Advantage Liberty (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,472.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,435.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,435.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,435.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.33 |
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 |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$60.00 | $120.00 | None | $1,445.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$85.00 | $170.00 | None | $1,444.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Non-Preferred Drug |
$85.00 | $170.00 | None | $1,444.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
25% | n/a | None | $1,433.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.38 |
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 |
Simply Extra (HMO)
|
$0.00 |
$100 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
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 |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
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 |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
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 |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.42 |
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 |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.90 |
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 |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
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 |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
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 |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
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 |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom (PPO)
|
$0.00 |
$125 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
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 |
Simply Freedom Extra (PPO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
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 |
Simply Freedom Extra (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Freedom Extra (PPO)
|
$0.00 |
$150 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$10.00 | n/a | None | $1,433.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$40.00 | n/a | None | $1,434.10 |
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 |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
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 |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
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 |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,434.10 |
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 |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$100.00 | n/a | None | $1,433.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$5.00 | n/a | None | $1,433.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$55.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
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 |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,434.10 |
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 |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$5.00 | n/a | None | $1,433.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.23 |
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 |
Simply More Platinum (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Brand |
$75.00 | n/a | None | $1,433.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,444.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,447.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,445.28 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,459.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC MedicareMax Complete Care FL-0030 (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$65.00 | $185.00 | Q:480 /30Days | $1,468.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC MedicareMax Complete Care FL-0030 (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$65.00 | $185.00 | Q:480 /30Days | $1,468.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC MedicareMax Medicare Advantage FL-0028 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$65.00 | $185.00 | Q:480 /30Days | $1,467.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC MedicareMax Medicare Advantage FL-0029 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,469.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Preferred Complete Care FL-0003 (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$45.00 | $125.00 | Q:480 /30Days | $1,467.98 |
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 Preferred Medicare Advantage FL-0001 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$40.00 | $110.00 | Q:480 /30Days | $1,467.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Preferred Medicare Advantage FL-0002 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,469.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Preferred Medicare Advantage FL-002P (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,469.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC The Villages Medicare Advantage FL-0004 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,469.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC The Villages Medicare Advantage FL-0004 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,469.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC The Villages Medicare Advantage FL-0004 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,469.42 |
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 The Villages Medicare Advantage FL-004P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $260.00 | Q:480 /30Days | $1,469.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC The Villages Medicare Advantage FL-004P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $260.00 | Q:480 /30Days | $1,469.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC The Villages Medicare Advantage FL-004P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$90.00 | $260.00 | Q:480 /30Days | $1,469.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$14.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$16.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,432.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP)
|
$25.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,469.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
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 |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Advantage Plus (HMO)
|
$26.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
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 |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
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 |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
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 |
Simply Complete (HMO D-SNP)
|
$29.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$29.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$29.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$29.90 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,472.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,472.02 |
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 |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,472.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
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 Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
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 Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
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 Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
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 Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,473.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
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 |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
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 |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
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 |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Drug |
25% | 25% | None | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$34.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$34.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$34.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,434.10 |
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 FL-F002 (PPO I-SNP)
|
$35.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:480 /30Days | $1,471.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,433.33 |
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 |
Simply Complete Platinum (HMO D-SNP)
|
$37.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,432.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,400.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,430.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,430.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,430.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,418.78 |
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 |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,418.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,418.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,418.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,418.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,418.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,435.68 |
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 |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,435.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,435.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
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 |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,448.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,454.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,454.11 |
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 |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,454.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,454.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Total (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,460.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Total (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,460.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | None | $1,376.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,429.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,431.84 |
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 |
Simply Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,431.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,431.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,431.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,434.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,434.10 |
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 |
Simply Complete Platinum (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,430.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | None | $1,430.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,473.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
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 FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
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 FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
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 FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
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 FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,477.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
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 FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,476.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,470.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D005 (Regional PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,473.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
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 FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
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 FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
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 FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D006 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,483.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
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 |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
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 |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
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 |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
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 |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
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 |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-Y001 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
$0.00 | $0.00 | Q:480 /30Days | $1,474.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC MedicareMax Medicare Advantage FL-D004 (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,468.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC MedicareMax Medicare Advantage FL-D004 (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,468.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Preferred Dual Complete FL-D001 (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,468.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Preferred Dual Complete FL-D001 (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,468.61 |
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 Preferred Dual Complete FL-D01P (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | Q:480 /30Days | $1,469.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Freedom (HMO-POS)
|
$64.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:480 /30Days | $1,472.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
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 |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Capital Health Plan Preferred Advantage (HMO)
|
$86.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$95.00 | $237.50 | Q:480 /30Days | $1,438.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
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 |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
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 |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
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 |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
|
$97.70 |
$305 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:480 /30Days | $1,444.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Signature (HMO-POS)
|
$168.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:480 /30Days | $1,472.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Champion (HMO-POS C-SNP)
|
$188.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:480 /30Days | $1,472.21 |
Browse Plan Formulary all covered insulin pay $35 or less |