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2024 Medicare Part D Plan’s Negotiated Retail Drug Price

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2024 Medicare Prescription Drug Price Information
Horizon Medicare Blue Rx Enhanced (PDP) (S5993-003-0)
Benefits & Contact Info         
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.

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Horizon Medicare Blue Rx Enhanced (PDP) Formulary
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0-9 
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin]  
Plan’s average negotiated retail drug price in
CMS PDP Region 4, includes: NJ
$49.06* 30-Day Supply
$138.01* 90-Day Supply
Formulary (Drug List) drug tier:Tier #2: Generic
Does this plan offer any Gap coverage?Yes
Does this drug have Gap coverage?Yes, this drug has coverage in the gap and brand-name drugs receive an additional, partial donut hole discount.
Drug Usage Management Restrictions:None
Formulary (Drug List) Tier Cost-Sharing Details
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.
  30-Day Supply
Cost-Sharing
90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order** Preferred Pharmacy Standard Pharmacy Mail- Order**
This plan does not have an Initial Deductible:
 n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing:
 $8.00 $8.00 $4.00 $24.00 $24.00 $12.00
Coverage Gap Phase Cost-Sharing:
 $8.00 $8.00 $4.00 $24.00 $24.00 $12.00
Plus Additional Donut Hole Discount  
(Generics 75%):
 25% 25% 25% 25% 25% 25%
Plus Additional Donut Hole Discount  
(Brand 75%):
 25% 25% 25% 25% 25% 25%
Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs):
 $0$0$0 $0$0$0
Your Estimated Cost for Purchases During Each Coverage Phase
  30-Day Supply
Cost-Sharing
90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order** Preferred Pharmacy Standard Pharmacy Mail- Order**
Your Estimated Cost Initial Coverage Phase:
 $8.00 $8.00 $4.00 $24.00 $24.00 $12.00
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $12.27$12.27$12.27 $34.50$34.50$34.50
Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs):
 $0$0$0 $0$0$0
Tier Cost-Sharing Details and Your Costs with Explanations
  30-Day Supply
Cost-Sharing
90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order** Preferred Pharmacy Standard Pharmacy Mail- Order**
--- If you purchase during the Initial Deductible Phase ---
This plan does not have an Initial Deductible:
 n/an/an/an/an/an/a
--- If you purchase during the Initial Coverage Phase ---
Initial Coverage Phase Cost-Sharing:
 $8.00 $8.00 $4.00 $24.00 $24.00 $12.00
Your Estimated Cost Initial Coverage Phase:
 $8.00 $8.00 $4.00 $24.00 $24.00 $12.00
Explanation for 30-Day Preferred Pharmacy purchase:
 The cost-sharing for purchases made during the initial coverage phase (ICP) would be a flat fee of $8.00.
--- If you purchase during the Coverage Gap Phase (Donut Hole) ---
Coverage Gap Phase Cost-Sharing:
 $8.00 $8.00 $4.00 $24.00 $24.00 $12.00
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $12.27$12.27$12.27 $34.50$34.50$34.50
--- If you purchase during the Catastrophic Coverage Phase ---
Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs):
 $0$0$0 $0$0$0
Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs):
 $0$0$0 $0$0$0
Explanation for 30-Day Preferred Pharmacy purchase:
 Beginning with plan year 2024, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches $8,000 -- the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP).
Horizon Medicare Blue Rx Enhanced (PDP)
Average Negotiated Retail Drug Price History
 30-Day Supply90 Day Supply
March, 2024: $49.06$138.01
January, 2024: $48.80$137.10
September, 2023: $55.41$156.89
June, 2023: $53.40$150.60
March, 2023: $52.40$147.60
January, 2023: $52.40$147.60
September, 2022: $48.40$135.60
June, 2022: $48.40$135.60
March, 2022: $48.40$135.60
January, 2022: $48.00$136.20
September, 2021: $47.40$134.40
June, 2021: $47.40$134.40
March, 2021: $47.20$134.40
January, 2021: $47.00$131.40
September, 2020: $47.80$135.00
June, 2020: $47.80$135.00
March, 2020: $47.80$135.00
January, 2020: $47.80$135.60
September, 2019: $48.11$134.62
June, 2019: $48.12$134.62
March, 2019: $48.39$136.90
January, 2019: $48.43$137.43
September, 2018: $48.48$137.54
June, 2018: $48.49$137.55
March, 2018: $48.27$135.76
January, 2018: $48.32$135.81
September, 2017: $48.81$144.00
June, 2017: $48.83$144.01
March, 2017: $48.74$143.74
January, 2017: $48.76$143.76
September, 2016: $48.77$143.77
June, 2016: $48.77$143.77
April, 2016: $48.90$144.14
January, 2016: $48.90$144.07
September, 2015: $38.50$112.89
June, 2015: $20.82$59.82
April, 2015: $23.46$67.67
January, 2015: $20.88$59.88
September, 2014: $59.87$176.87
June, 2014: $59.87$176.87
March, 2014: $73.00$216.16
January, 2014: $73.02$216.18
October, 2013: $77.06$229.04
January, 2013: $77.71--
April, 2012: $77.51--
September, 2010: $77.52--
Notes:
*The Medicare drug plan’s average negotiated retail drug price is based on several variables: the medication, the quantity of your prescription, the specific Medicare Part D plan, and the pharmacies in the plan’s service area. In this case, the average of the AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin] prices that the Horizon Medicare Blue Rx Enhanced (PDP) has negotiated with each of the retail pharmacies in the plan’s service area (CMS PDP Region 4, includes: NJ). In other words, when you use the Horizon Medicare Blue Rx Enhanced (PDP) to purchase AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin], you may pay slightly more or slightly less than the figures shown in the table above depending on the pharmacy where you fill your prescription and the quantity of your prescription. The example average retail prices used above are based on a quantity of 20 for the 30-day supply and a quantity of 60 for the 90-day supply.

**The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.

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Chart Legend:

What does all this mean? Below are a few notes to help you understand the above 2024 Medicare Part D Horizon Medicare Blue Rx Enhanced (PDP) Plan Formulary.