CYLTEZO(CF) 20 MG/0.4 ML SYRINGEKIT (UNITS ) (NDC: 00597040580)
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 IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0006 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0007 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0008 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0008 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0008 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0008 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0008 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0008 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0008 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0009 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0010 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0010 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0010 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0010 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0010 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0010 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0010 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0011 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0012 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0013 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0014 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0015 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0016 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0017 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0018 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0019 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0019 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0019 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0019 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0019 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0019 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0019 (HMO-POS)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-001P (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-001P (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-001P (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-001P (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-001P (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-001P (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0020 (HMO-POS)
|
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-049 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-051 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-053 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-071 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-071 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-071 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
|
$0.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-112 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-114 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-192 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-226 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-226 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-226 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-229 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-309 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-317 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-317 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-317 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-322 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-322 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-322 (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-378 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Complete No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$175 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Open (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
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 |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$19.80 |
$505 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $6,331.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
|
$20.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-188 (PPO)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-188 (PPO)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-188 (PPO)
|
$22.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage IN-E001 (PPO I-SNP)
|
$23.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan IN-F001 (PPO I-SNP)
|
$23.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0001 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0003 (PPO)
|
$24.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0002 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0005 (PPO)
|
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0004 (PPO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0004 (PPO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0004 (PPO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0004 (PPO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0004 (PPO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
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 |
AARP Medicare Advantage from UHC IN-0004 (PPO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC IN-0004 (PPO)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$35.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-023 (PPO)
|
$36.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-023 (PPO)
|
$36.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-023 (PPO)
|
$36.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-023 (PPO)
|
$36.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S001 (PPO D-SNP)
|
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access (HMO D-SNP)
|
$37.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:2 /28Days | $6,336.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-019 (PPO)
|
$41.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated SNP-DE H5619-054 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-156 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-193 (PPO)
|
$42.30 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-D001 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
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 |
UHC Dual Complete IN-S002 (PPO D-SNP)
|
$42.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $7,077.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R0865-003 (Regional PPO)
|
$46.00 |
$245 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-008 (PPO)
|
$51.00 |
$220 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-053 (PPO)
|
$55.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-032 (PFFS)
|
$63.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-324 (PPO)
|
$77.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-324 (PPO)
|
$77.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-324 (PPO)
|
$77.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-107 (PPO)
|
$123.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-107 (PPO)
|
$123.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-107 (PPO)
|
$123.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $6,572.65 |
Browse Plan Formulary all covered insulin pay $35 or less |