APTIOM 200 MG TABLET (30 EA ) (NDC: 63402020230)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC WI-0008 (PPO)
|
$0.00 |
$450 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0008 (PPO)
|
$0.00 |
$450 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0008 (PPO)
|
$0.00 |
$450 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0008 (PPO)
|
$0.00 |
$450 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
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 WI-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
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 WI-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
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 |
AARP Medicare Advantage from UHC WI-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage Walgreens from UHC WI-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
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 (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
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 SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
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 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
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 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
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 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
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 Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
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 Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,309.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,309.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
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 Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,309.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
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 Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
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 Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,243.09 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
|
$0.00 |
$195 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S | $1,250.18 |
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 |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aspirus Health Plan Essential Rx (PPO)
|
$0.00 |
$245 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:180 /30Days | $2,151.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Essential (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $2,030.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
EssentiaCare Access (PPO)
|
$0.00 |
$345 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Access (PPO)
|
$0.00 |
$345 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Access (PPO)
|
$0.00 |
$345 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Esteem Rx (HMO-POS)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
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 |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
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 |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
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 |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Birch (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-001 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-253 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
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 H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
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 H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-356 (PPO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
|
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Anywhere (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Anywhere (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,172.89 |
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 |
Network Health Anywhere (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Anywhere (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Anywhere (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Anywhere (PPO)
|
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Choice (PPO)
|
$0.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Go (PPO)
|
$0.00 |
$195 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Go (PPO)
|
$0.00 |
$195 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Go (PPO)
|
$0.00 |
$195 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Go (PPO)
|
$0.00 |
$195 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,172.89 |
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 |
Network Health Go (PPO)
|
$0.00 |
$195 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,172.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Select (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Zero (PPO)
|
$0.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,196.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0001 (PPO C-SNP)
|
$12.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Dual Advantage (HMO D-SNP)
|
$15.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$16.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier (PPO)
|
$17.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$17.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$17.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$17.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$17.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$17.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care WI-0003 (PPO C-SNP)
|
$18.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
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 (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
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 (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$19.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Secure (PPO)
|
$19.00 |
$295 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Secure (PPO)
|
$19.00 |
$295 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Secure (PPO)
|
$19.00 |
$295 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (HMO-POS I-SNP)
|
$22.10 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.15 |
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 |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$23.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Partnership Plan (HMO D-SNP)
|
$23.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,325.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$28.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$28.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$28.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0010 (HMO-POS)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0010 (HMO-POS)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0010 (HMO-POS)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
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 WI-0010 (HMO-POS)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0010 (HMO-POS)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0010 (HMO-POS)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,426.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$29.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$29.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (PPO)
|
$29.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier (PPO)
|
$29.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,320.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care Select (HMO D-SNP)
|
$31.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
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 |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0007 (PPO)
|
$33.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
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 |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
|
$33.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,189.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0012 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0012 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
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 |
AARP Medicare Advantage from UHC WI-0012 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0012 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0012 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0012 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,367.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
|
$34.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
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 Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
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 Plus (PPO)
|
$34.00 |
$400 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
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 Medicare Advantage 3 (PPO)
|
$34.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | S | $1,250.18 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
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 WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
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 WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
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 WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP)
|
$34.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $1,425.12 |
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 WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0011 (HMO-POS)
|
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,359.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0004 (PPO)
|
$37.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $1,363.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
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 Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage (HMO D-SNP)
|
$39.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | S | $1,250.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,209.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
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 H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
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 H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-006 (PPO)
|
$40.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0002 (PPO)
|
$41.00 |
$325 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Dual Complete WI-D003 (HMO-POS D-SNP)
|
$43.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,424.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
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 |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
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 |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
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 |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
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 |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
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 |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
|
$48.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $1,319.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
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 |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
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 |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
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 |
Ally Rx (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $1,233.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Dual Eligible (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | S Q:60 /30Days | $1,232.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
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 |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Community Care's Partnership Program (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | None | $1,257.62 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
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 |
Cooperative Advantage (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | n/a | Q:180 /30Days | $1,194.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-173 (PPO)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Family Care Partnership (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | S Q:30 /30Days | $1,227.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Family Care Partnership (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | S Q:30 /30Days | $1,227.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Family Care Partnership (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | S Q:30 /30Days | $1,227.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Family Care Partnership (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | S Q:30 /30Days | $1,227.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Family Care Partnership (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | S Q:30 /30Days | $1,227.53 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
iCare Medicare Plan (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $1,228.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health Cares (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage WI-E001 (HMO-POS I-SNP)
|
$48.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,427.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D001 (PPO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-D002 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
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 WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete WI-V001 (HMO-POS D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $1,425.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP)
|
$48.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Dean Advantage Assurance (HMO-POS)
|
$50.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P | $2,028.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
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 |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
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 |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthPartners Robin Maple (PPO)
|
$50.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P | $1,226.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Ascend Rx (HMO-POS)
|
$53.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-359 (PPO)
|
$55.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-359 (PPO)
|
$55.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-359 (PPO)
|
$55.00 |
$400 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)
|
$64.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
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 |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$67.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,232.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-397 (PPO)
|
$69.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-397 (PPO)
|
$69.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-397 (PPO)
|
$69.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PlusRx (PPO)
|
$73.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
|
$74.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Grand (PPO)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Grand (PPO)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
EssentiaCare Grand (PPO)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:180 /30Days | $1,968.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Thrift w/Rx (Cost)
|
$79.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,181.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
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 |
HumanaChoice H5216-001 (PPO)
|
$84.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,204.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Essence Rx (HMO-POS)
|
$88.00 |
$330 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
26% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Balance (HMO-POS)
|
$97.00 |
$100 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | P | $2,028.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5361-002 (Regional PPO)
|
$97.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,204.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-063 (PPO)
|
$99.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-063 (PPO)
|
$99.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-063 (PPO)
|
$99.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,208.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC WI-0005 (PPO)
|
$108.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,479.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$124.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Focus w/Rx (Cost)
|
$141.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
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 H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
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 H5216-168 (PPO)
|
$148.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,270.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
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 |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
|
$167.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,304.69 |
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 Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
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 Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Enhanced Select (PPO)
|
$169.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | Q:30 /30Days | $1,250.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
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 |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Spirit Rx (HMO-POS)
|
$243.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,232.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Network Health PremierRx (PPO)
|
$244.00 |
$260 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,197.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dean Advantage Complete (HMO)
|
$251.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $2,029.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Prime Solution Total w/Rx (Cost)
|
$266.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:180 /30Days | $1,223.77 |
Browse Plan Formulary all covered insulin pay $35 or less |