CAMZYOS 2.5 MG CAPSULE (CAPSULES ) (NDC: 73625011111)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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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 |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Choice Rx (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Community HMO Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Community HMO Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Community HMO Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Community Select (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Community Select (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Community Select (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-014 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-014 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H0028-014 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-014 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-014 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-014 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-014 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-007 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-013 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-013 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-013 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-013 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1468-013 (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-215 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-251 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-318 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-068 (PPO)
|
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Advantage with SSM Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,074.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Medica Advantage with SSM Value (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,074.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
OSF with Medica Advantage Select (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Select (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Select (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Select (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Select (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Select (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
OSF with Medica Advantage Select (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
OSF with Medica Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Value (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $13,082.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)
|
$0.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Choice IL (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Choice IL (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Choice IL (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Choice IL (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Choice IL (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Choice IL (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Elite Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Select IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Select IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Select IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Elite Select IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing ESRD Select IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing ESRD Select IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing ESRD Select IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing ESRD Select IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Essential Wellness Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Care IL (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart IL (HMO C-SNP)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-283 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-399 (PPO)
|
$30.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)
|
$32.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)
|
$32.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)
|
$32.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)
|
$32.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)
|
$32.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)
|
$32.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)
|
$32.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | P Q:30 /30Days | $7,994.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | P Q:30 /30Days | $7,994.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | P Q:30 /30Days | $7,994.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | P Q:30 /30Days | $7,994.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Longevity Health Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | P Q:30 /30Days | $7,994.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P Q:30 /30Days | $8,665.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P Q:30 /30Days | $8,665.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P Q:30 /30Days | $8,665.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P Q:30 /30Days | $8,665.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P Q:30 /30Days | $8,665.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P Q:30 /30Days | $8,665.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Provider Partners Illinois Advantage Plan (HMO I-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P Q:30 /30Days | $8,665.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Zing Select Diabetes & Heart Complete IL (HMO C-SNP)
|
$32.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,671.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-006 (PFFS)
|
$40.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-014 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-014 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-014 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1468-014 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Basic Rx (HMO-POS)
|
$53.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-032 (PPO)
|
$61.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-032 (PPO)
|
$61.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-032 (PPO)
|
$61.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)
|
$68.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)
|
$68.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)
|
$68.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)
|
$68.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)
|
$68.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)
|
$68.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)
|
$68.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $8,469.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5361-002 (Regional PPO)
|
$97.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-013 (PPO)
|
$100.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-004 (PPO)
|
$100.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare HMO 20 Rx (HMO)
|
$125.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-122 (PFFS)
|
$132.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-122 (PFFS)
|
$132.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-357 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5525-069 (PPO)
|
$138.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $8,187.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Preferred (HMO-POS)
|
$160.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $13,079.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
OSF with Medica Advantage Preferred (HMO-POS)
|
$160.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $13,079.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Preferred (HMO-POS)
|
$160.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $13,079.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Preferred (HMO-POS)
|
$160.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $13,079.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Preferred (HMO-POS)
|
$160.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $13,079.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Preferred (HMO-POS)
|
$160.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $13,079.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
OSF with Medica Advantage Preferred (HMO-POS)
|
$160.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $13,079.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS 10 Rx (HMO-POS)
|
$165.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Health Alliance Medicare POS Enrich Rx (HMO-POS)
|
$165.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $8,221.84 |
Browse Plan Formulary all covered insulin pay $35 or less |