AVONEX PEN 30 MCG/0.5 ML KIT (1 EA ) (NDC: 59627033304)
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 |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
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 ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0002 (PPO)
|
$0.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
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 ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
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 ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0005 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
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 I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
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 I MaineHealth Advantage Plus (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
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 |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
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 |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:1 /28Days | $8,359.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $8,307.17 |
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 Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health ME-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
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 |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
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 |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$16.70 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,074.07 |
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 I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Extra (HMO)
|
$19.10 |
$275 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
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 |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
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 |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$20.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,077.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
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 I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,078.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
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 I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
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 I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
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 I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP)
|
$23.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:4 /28Days | $8,124.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$29.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$29.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$29.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Value Plan (HMO)
|
$29.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$29.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (HMO)
|
$29.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:1 /28Days | $8,442.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:1 /28Days | $8,442.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:1 /28Days | $8,442.89 |
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 Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:1 /28Days | $8,442.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:1 /28Days | $8,442.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:1 /28Days | $8,442.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:1 /28Days | $8,442.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Plus Plan (HMO-POS D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:1 /28Days | $8,133.59 |
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 ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
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 ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S001 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
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 ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
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 ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete ME-S003 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,307.17 |
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 Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | Q:1 /28Days | $8,307.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,074.07 |
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 I MaineHealth Advantage Access (PPO)
|
$44.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
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 |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Plan (PPO)
|
$49.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:1 /28Days | $8,133.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
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 ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
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 ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC ME-0003 (PPO)
|
$54.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:1 /28Days | $8,378.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MH-0001 (Regional PPO)
|
$58.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:1 /28Days | $8,358.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,074.07 |
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 I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem I MaineHealth Advantage Choice (HMO-POS)
|
$76.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:4 /28Days | $8,074.07 |
Browse Plan Formulary all covered insulin pay $35 or less |