ABILIFY MAINTENA ER 300 MG VIAL (1 EA ) (NDC: 59148001871)
2024 Medicare Prescription Drug Plan (MAPD) Information
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC MA-0001 (HMO-POS)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | None | $2,235.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MA-0005 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | None | $2,235.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Plan (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,081.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,081.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,081.53 |
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 |
CCA Medicare Preferred (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $3,267.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA One Care (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Tier 3 |
0% | 0% | Q:1 /28Days | $3,267.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Forever (HMO)
|
$0.00 |
$185 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | None | $2,093.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Freedom (PPO)
|
$0.00 |
$185 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | None | $2,093.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Give Back (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | None | $2,093.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Orange (HMO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | None | $2,111.74 |
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 |
Mass General Brigham Advantage (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,065.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue SaverRx (HMO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $2,031.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue SaverRx (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,031.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Health One Care (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Tier 3 |
0% | 0% | None | $2,094.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred Access Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,102.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Saver Rx (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | None | $2,102.34 |
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 |
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,102.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
UnitedHealthcare Connected(r) for One Care (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | None | $2,198.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
47% | 47% | Q:1 /28Days | $2,238.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
48% | 48% | Q:1 /28Days | $2,238.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
43% | 43% | Q:1 /28Days | $2,238.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Whole Health NHC (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:1 /28Days | $1,998.90 |
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 |
CCA Medicare Value (PPO)
|
$20.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $3,267.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Health Plan Senior Care Options (HMO D-SNP)
|
$24.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,094.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Health Plan Senior Care Options CW (HMO D-SNP)
|
$24.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,094.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth ForeverMore (HMO)
|
$25.00 |
$170 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | None | $2,093.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Senior Care Options MA-Y001 (HMO D-SNP)
|
$26.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | None | $2,323.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$27.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $2,081.53 |
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 |
Medicare HMO Blue ValueRx (HMO)
|
$28.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | Q:1 /28Days | $2,032.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue ValueRx (HMO)
|
$28.00 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | Q:1 /28Days | $2,015.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Whole Health (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:1 /28Days | $1,998.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Senior Care Options NHC MA-Y002 (HMO D-SNP)
|
$31.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | None | $2,323.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
CCA Senior Care Options (HMO D-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:1 /28Days | $3,267.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$43.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:1 /28Days | $2,104.29 |
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 MA-0002 (HMO-POS)
|
$49.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | None | $2,235.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$51.00 |
$225 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | None | $2,092.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$51.00 |
$225 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | None | $2,109.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Basic Rx (HMO)
|
$51.00 |
$225 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | None | $2,104.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mass General Brigham Advantage Secure (HMO-POS)
|
$52.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,065.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NG-0001 (Regional PPO)
|
$58.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | None | $2,263.51 |
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 |
Fallon Medicare Plus Super Saver (HMO)
|
$60.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | None | $2,111.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue ValueRx (PPO)
|
$72.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,032.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue ValueRx (PPO)
|
$72.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,015.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Enhanced Open (PPO)
|
$75.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
48% | 48% | Q:1 /28Days | $2,238.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Green (HMO)
|
$78.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | None | $2,134.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Green (HMO)
|
$78.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | None | $2,119.51 |
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 |
Fallon Medicare Plus Green (HMO)
|
$78.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | None | $2,109.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue FlexRx (HMO-POS)
|
$78.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $2,032.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue FlexRx (HMO-POS)
|
$78.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $2,015.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Mass General Brigham Advantage Premier (PPO)
|
$140.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $2,065.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,092.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,109.97 |
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 |
Tufts Medicare Preferred HMO Value Rx (HMO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,104.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Blue (HMO)
|
$174.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | None | $2,134.57 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Blue (HMO)
|
$174.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | None | $2,119.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Fallon Medicare Plus Blue (HMO)
|
$174.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | None | $2,109.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$186.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,091.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$186.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,095.72 |
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 |
Tufts Medicare Preferred HMO Prime Rx (HMO)
|
$186.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,088.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare HMO Blue PlusRx (HMO)
|
$220.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $2,031.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,095.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,088.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
|
$220.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $2,091.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medicare PPO Blue PlusRx (PPO)
|
$238.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $2,031.98 |
Browse Plan Formulary all covered insulin pay $35 or less |