ABILIFY ASIMTUFII 720 MG/2.4ML SUSER SYRINGE (MLS ) (NDC: 59148010280)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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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 |
Anthem Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,633.00 |
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 |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,416.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Savings Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,416.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Medicare (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,416.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-021 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-021 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-021 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-021 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,522.74 |
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 |
Humana USAA Honor with Rx (PPO)
![Email Prescription and/or Health Benefit details for Humana USAA Honor with Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-285 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-285 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-309 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Access (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Access (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
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 |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Signature (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Signature (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Signature (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Signature (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Perennial Advantage Freedom (HMO-POS)
![Email Prescription and/or Health Benefit details for Perennial Advantage Freedom (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:2.4 /56Days | $6,152.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Perennial Advantage Premier (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for Perennial Advantage Premier (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:2.4 /56Days | $6,153.74 |
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 |
The Health Plan SecureCare - Option II (HMO)
![Email Prescription and/or Health Benefit details for The Health Plan SecureCare - Option II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,388.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureChoice Optimum (PPO)
![Email Prescription and/or Health Benefit details for The Health Plan SecureChoice Optimum (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,388.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureChoice Optimum (PPO)
![Email Prescription and/or Health Benefit details for The Health Plan SecureChoice Optimum (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,388.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
![Email Prescription and/or Health Benefit details for Humana Together in Health (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Extra Help (HMO)
![Email Prescription and/or Health Benefit details for Anthem Extra Help (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 2 (HMO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:2.4 /56Days | $3,680.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Plus Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,416.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-055 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-055 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-042 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-042 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Secure (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Secure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Secure (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Secure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
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 |
Cigna TotalCare (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Cigna TotalCare (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:2.4 /56Days | $3,416.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-023 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-023 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5525-041 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5525-041 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Cigna TotalCare Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:2.4 /56Days | $3,416.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Full Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:2.4 /56Days | $3,680.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
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 |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureCare SNP (HMO D-SNP)
![Email Prescription and/or Health Benefit details for The Health Plan SecureCare SNP (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:2.4 /56Days | $3,395.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareSource Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CareSource Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:2.4 /56Days | $3,395.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:2.4 /56Days | $3,522.74 |
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 |
HumanaChoice SNP-DE H5525-046 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for HumanaChoice SNP-DE H5525-046 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Perennial Advantage Strive (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Perennial Advantage Strive (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:2.4 /56Days | $6,155.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Valor Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Valor Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | Q:2.4 /56Days | $3,728.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage 3 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
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 |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5495-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5495-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-032 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (Regional PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,633.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
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 |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$90.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
The Health Plan SecureChoice - Option II (PPO)
![Email Prescription and/or Health Benefit details for The Health Plan SecureChoice - Option II (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$93.40 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,388.71 |
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 |
HumanaChoice H5525-030 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-030 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$115.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:2.4 /56Days | $3,522.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$129.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
32% | n/a | Q:2.4 /56Days | $3,390.91 |
Browse Plan Formulary all covered insulin pay $35 or less |