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2024 Medicare Part D Plan’s Negotiated Retail Drug Price
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2024 Medicare Advantage Prescription Drug Price Information
Wellcare Dual Access Open (PPO D-SNP) (H5199-016-0)
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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Wellcare Dual Access Open (PPO D-SNP) Formulary
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MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera]  
Plan’s average negotiated retail drug price in
in Alachua, FL: CMS MA Region 9, includes: FL 		n/a* 30-Day Supply
n/a 90-Day Supply (calculated)
Formulary (Drug List) drug tier:Tier 1
Does this plan offer any Gap coverage?No Gap Coverage
Does this drug have Gap coverage?No, this drug IS NOT covered in the gap, but all drugs receive the 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**
Initial $545 Deductible Cost Sharing:
 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing:
 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Generics 75%):
 25% 25% 25% 25% 25% 25%
Coverage Gap Phase Cost-Sharing Incl. 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 in Deductible Phase:
 TBD TBD TBD TBD TBD TBD
Your Estimated Cost Initial Coverage Phase:
 TBD TBD TBD TBD TBD TBD
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 TBDTBDTBD TBDTBDTBD
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 TBDTBDTBD TBDTBDTBD
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 ---
Initial $545 Deductible Cost Sharing:
 100% 100% 100% 100% 100% 100%
Your Estimated Cost in Deductible Phase:
 TBD TBD TBD TBD TBD TBD
--- If you purchase during the Initial Coverage Phase ---
Initial Coverage Phase Cost-Sharing:
 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Your Estimated Cost Initial Coverage Phase:
 TBD TBD TBD TBD TBD TBD
--- If you purchase during the Coverage Gap Phase (Donut Hole) ---
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 TBDTBDTBD TBDTBDTBD
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 TBDTBDTBD TBDTBDTBD
--- 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).
Wellcare Dual Access Open (PPO D-SNP)
Average Negotiated Retail Drug Price History
 30-Day Supply90 Day Supply
March, 2024: n/an/a
January, 2024: $28.48$81.94
September, 2023: n/an/a
June, 2023: n/an/a
March, 2023: $32.93$98.79
January, 2023: n/an/a
September, 2022: n/an/a
June, 2022: n/an/a
March, 2022: n/an/a
January, 2022: n/an/a
September, 2021: n/an/a
June, 2021: n/an/a
March, 2021: n/an/a
January, 2021: n/an/a
September, 2020: n/an/a
June, 2020: n/an/a
March, 2020: n/an/a
January, 2020: n/an/a
September, 2019: 
June, 2019: 
March, 2019: 
January, 2019: 
September, 2018: 
June, 2018: 
March, 2018: 
January, 2018: 
September, 2017: 
June, 2017: 
March, 2017: 
January, 2017: 
September, 2016: 
June, 2016: 
April, 2016: 
January, 2016: 
September, 2015: 
June, 2015: 
April, 2015: 
January, 2015: 
September, 2014: 
June, 2014: 
March, 2014: 
January, 2014: 
October, 2013: 
January, 2013: --
April, 2012: --
September, 2010: --
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 MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera] prices that the Wellcare Dual Access Open (PPO D-SNP) has negotiated with each of the retail pharmacies in the plan’s service area (in Alachua, FL: CMS MA Region 9, includes: FL). In other words, when you use the Wellcare Dual Access Open (PPO D-SNP) to purchase MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera], 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 mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.

Return to the Wellcare Dual Access Open (PPO D-SNP) 2024 Formulary Browser by choosing a letter below:
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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 Wellcare Dual Access Open (PPO D-SNP) Plan Formulary.