AUVELITY ER 45-105 MG TABLET IR ER (60 UNITS ) (NDC: 81968004530)
2024 Medicare Prescription Drug Plan (MAPD) Information
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC OR-0002 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $1,157.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OR-0004 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $1,195.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OR-0004 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $1,157.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite Plan (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $1,093.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit Elite Plan (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,093.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Value Plan (HMO-POS)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $1,093.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
ATRIO Choice Rx (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | S | $1,075.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,050.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,050.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE Oregon (PPO)
|
$0.00 |
$225 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $1,039.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Oregon (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $1,039.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
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 (HMO C-SNP)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days | $1,063.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-153 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days | $1,063.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-247 (PPO)
|
$0.00 |
$125 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days | $1,057.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$90.00 | $180.00 | None | $1,129.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Moda Health Elements PPORX (PPO)
|
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$93.00 | $232.50 | S Q:60 /30Days | $1,722.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
PacificSource Medicare Explorer Rx 11 (PPO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | Q:60 /30Days | $1,057.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,057.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
PacificSource Medicare MyCare Rx 40 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,057.31 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Prime + Rx (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:2 /1Days | $1,075.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence BlueAdvantage HMO (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,124.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence BlueAdvantage HMO (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,124.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence BlueAdvantage HMO (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,067.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Regence MedAdvantage + Rx Primary (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | Q:60 /30Days | $1,124.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Primary (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | Q:60 /30Days | $1,078.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Primary (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | Q:60 /30Days | $1,067.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback Open (PPO)
|
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,069.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,074.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$425 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,069.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare No Premium Open (PPO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,069.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CHOICE PLUS Oregon (PPO)
|
$12.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:60 /30Days | $1,039.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$16.60 |
$380 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,069.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Choice Plan (PPO)
|
$20.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $1,093.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plus Plan (HMO-POS)
|
$20.70 |
$400 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
40% | 40% | P Q:60 /30Days | $1,093.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care OR-001A (PPO C-SNP)
|
$21.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,157.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Wellcare Low Premium Open (PPO)
|
$24.00 |
$350 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,069.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan OR-F002 (PPO I-SNP)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,175.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Bridge + Rx (HMO-POS)
|
$29.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:2 /1Days | $1,079.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan OR-F001 (PPO I-SNP)
|
$30.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,157.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage RI-E002 (PPO I-SNP)
|
$33.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | None | $1,222.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-294 (PPO)
|
$36.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $1,063.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage from UHC OR-0001 (PPO)
|
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $1,157.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Moda Health + Fred Meyer PPORX (PPO)
|
$39.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$93.00 | $232.50 | S Q:60 /30Days | $1,722.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeRight Advantage Health Plan (HMO I-SNP)
|
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | S Q:60 /30Days | $1,721.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
ATRIO Select Rx (PPO)
|
$40.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | S | $1,075.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareOregon Advantage Plus (HMO-POS D-SNP)
|
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
25% | 25% | P Q:2 /1Days | $1,063.22 |
Browse Plan Formulary all covered insulin pay $35 or less |
PacificSource Dual Care (HMO D-SNP)
|
$40.60 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | Q:60 /30Days | $1,058.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Providence Medicare Dual Plus (HMO D-SNP)
|
$40.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S Q:2 /1Days | $1,075.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage OR-E001 (PPO I-SNP)
|
$40.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | None | $1,157.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence BlueAdvantage HMO Plus (HMO)
|
$41.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $1,067.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence BlueAdvantage HMO Plus (HMO)
|
$41.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | Q:60 /30Days | $1,124.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Classic (PPO)
|
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,067.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Classic (PPO)
|
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,124.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Regence MedAdvantage + Rx Classic (PPO)
|
$44.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,078.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Standard (HMO-POS)
|
$46.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$90.00 | $180.00 | None | $1,129.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Extra Part B Only + Rx (HMO)
|
$49.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | S Q:2 /1Days | $1,079.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeRight Advantage Plus Health Plan (HMO I-SNP)
|
$55.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days | $1,721.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
AgeRight Advantage Premier Health Plan (HMO C-SNP)
|
$55.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:60 /30Days | $1,721.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC OR-0003 (HMO-POS)
|
$58.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | None | $1,157.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Providence Medicare Choice + Rx (HMO-POS)
|
$71.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:2 /1Days | $1,079.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
Moda Health Metro PPORX (PPO)
|
$86.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$93.00 | $232.50 | S Q:60 /30Days | $1,722.43 |
Browse Plan Formulary all covered insulin pay $35 or less |
ATRIO Prime Rx (PPO)
|
$125.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | S | $1,075.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Kaiser Permanente Senior Advantage Enhanced (HMO-POS)
|
$131.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$90.00 | $180.00 | None | $1,129.00 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Ultra Open (PPO)
|
$139.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $1,069.90 |
Browse Plan Formulary all covered insulin pay $35 or less |
Providence Medicare Extra + Rx (HMO)
|
$155.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:2 /1Days | $1,075.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Regence MedAdvantage + Rx Enhanced (PPO)
|
$166.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,078.61 |
Browse Plan Formulary all covered insulin pay $35 or less |
Regence MedAdvantage + Rx Enhanced (PPO)
|
$166.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | Q:60 /30Days | $1,067.33 |
Browse Plan Formulary all covered insulin pay $35 or less |