TELMISARTAN-HCTZ 40-12.5 MG TABLET [Micardis HCT] (30 tablets ) (NDC: 62332020930)
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 VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0002 (HMO-POS)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0003 (PPO)
|
$0.00 |
$0 | Yes, this drug has Gap Coverage. | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
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 |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-058 (PPO)
|
$0.00 |
$350* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-138 (PPO)
|
$0.00 |
$395* | Yes, but No Gap Coverage for this drug. | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Select (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
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 |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom PPO (PPO)
|
$0.00 |
$250* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
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 |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
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 |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Unity HMO (HMO)
|
$0.00 |
$225* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545* | Yes, this drug has Gap Coverage. | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 6 |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist Open (PPO)
|
$22.50 |
$420* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Plus Open (PPO)
|
$27.60 |
$215* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | Q:30 /30Days | $3.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VT-0001 (HMO-POS)
|
$28.00 |
$295* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Medicare Advantage VT-001A (PPO)
|
$43.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:30 /30Days | $18.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Secure (PPO)
|
$53.90 |
$150* | No additional gap coverage, only the Donut Hole Discount | 2* |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 NG-0001 (Regional PPO)
|
$58.00 |
$395* | Yes, this drug has Gap Coverage. | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $13.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
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 |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
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 |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Vermont Blue Advantage Freedom Plus PPO (PPO)
|
$59.00 |
$200* | No additional gap coverage, only the Donut Hole Discount | 6* |
Tier 6 |
$0.00 | $0.00 | None | $88.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
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 |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-057 (PPO)
|
$69.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $33.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
MVP Medicare Secure Plus with Part D (HMO-POS)
|
$97.50 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Generic |
$15.00 | $30.00 | None | $65.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
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 |
UVM Health Advantage Preferred (PPO)
|
$127.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Generic |
$10.00 | $20.00 | None | $65.24 |
Browse Plan Formulary all covered insulin pay $35 or less |