ARIPIPRAZOLE 15 MG TABLET [Abilify] (30 TABLETS ) (NDC: 67877043303)
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0003 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0004 (PPO)
|
$0.00 |
$295 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
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 |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
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 |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $38.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Freedom (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $44.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
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 |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
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 |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Giveback Choice (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $39.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare North Mississippi Health (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $47.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Signature (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $40.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Signature (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $40.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Signature (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $40.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Signature (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days | $40.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Capital (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $19.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Capital (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $19.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Capital (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $19.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
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 |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Magnolia (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $21.90 |
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 |
Blue Advantage Plus (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $18.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Plus (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $18.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Plus (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $18.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Plus (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P Q:30 /30Days | $18.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $8.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $9.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $15.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $15.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $15.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $15.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $15.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $15.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $15.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Access Medicare (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $10.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-151 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
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 |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
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 |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
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 |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-047 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice - Diabetes and Heart (PPO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-300 (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Classic (HMO-POS)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Giveback (HMO-POS)
|
$0.00 |
$195* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $201.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $178.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $201.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $178.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $201.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $178.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $201.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $201.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium (HMO)
|
$0.00 |
$275 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $178.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $137.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $159.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
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 |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual Assure (HMO D-SNP)
|
$20.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
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 |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
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 |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
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 |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
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 |
Cigna TotalCare Plus (HMO D-SNP)
|
$22.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$24.90 |
$440 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
46% | 46% | Q:30 /30Days | $154.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
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 |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
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 |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
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 |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna TotalCare (HMO D-SNP)
|
$25.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $9.34 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
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 |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $128.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Plus (HMO D-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium (HMO-POS)
|
$30.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days | $156.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$31.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC MS-0002 (PPO)
|
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Plus Medicare (HMO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $135.00 | Q:60 /30Days | $12.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $17.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $17.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $17.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $17.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $17.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $17.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Nursing Home Plan EX-F001 (PPO I-SNP)
|
$32.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $17.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Choice (PPO D-SNP)
|
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature (HMO D-SNP)
|
$35.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature (HMO D-SNP)
|
$35.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature (HMO D-SNP)
|
$35.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature (HMO D-SNP)
|
$35.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
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 |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $126.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature Select (HMO D-SNP)
|
$37.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature Select (HMO D-SNP)
|
$37.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Signature Select (HMO D-SNP)
|
$37.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Signature Select (HMO D-SNP)
|
$37.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $8.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S002 (HMO-POS D-SNP)
|
$37.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus (PPO)
|
$38.20 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days | $28.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-S001 (PPO D-SNP)
|
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 MS-V001 (HMO-POS D-SNP)
|
$39.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $17.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
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 |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Preferred (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | Q:30 /30Days | $9.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 Dual Select (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.04 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Dual Select Choice (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $10.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
American Health Advantage of Mississippi (HMO I-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $46.85 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 SNP-DE H1036-222 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
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 |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
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 |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
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 |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-160 (PPO)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-298 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Dual Plus (HMO-POS D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Primewell Reliance (HMO-POS)
|
$40.10 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$12.00 | $36.00 | Q:30 /30Days | $7.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Shared Health Dual Freedom (PPO D-SNP)
|
$40.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | Q:30 /30Days | $38.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 EX-E002 (PPO I-SNP)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage EX-E002 (PPO I-SNP)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage EX-E002 (PPO I-SNP)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage EX-E002 (PPO I-SNP)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days | $17.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-097 (PPO)
|
$53.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $5.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-097 (PPO)
|
$53.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $5.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
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 H5216-097 (PPO)
|
$53.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $5.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-097 (PPO)
|
$53.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $5.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-136 (PPO)
|
$59.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $6.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R0110-003 (Regional PPO)
|
$150.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $5.99 |
Browse Plan Formulary all covered insulin pay $35 or less |