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Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance 30-Day Supply | Total Formulary Drugs | |||
---|---|---|---|---|---|---|---|---|
SilverScript SmartRx (PDP) (S5601-192) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$7.30 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 49% Specialty Tier: 25% | 3,564 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance | Total Drugs | |||
---|---|---|---|---|---|---|---|---|
Indy Health EliteRx (PDP) (S3535-007) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$43.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $5.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33% | 3,578 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance |
State Members | |||
---|---|---|---|---|---|---|---|---|
SilverScript Choice (PDP) (S5601-034) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$24.70 | $340 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 45% Specialty Tier: 26% | 144,289 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Blue Cross MedicareRx Value (PDP) (S5715-001) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$80.00 | $445 | Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Drug: 46% Specialty Tier: 25% | 89,755 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Preferred (PDP) (S5820-016) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$81.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: 40% Specialty Tier: 33% | 83,815 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Basic Rx Plan (PDP) (S5884-107) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$27.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 32% Specialty Tier: 25% | 60,252 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Saver Plus (PDP) (S5921-362) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.60 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $8.00 Preferred Brand: $37.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 59,906 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
Plan Name Plan ID |
Monthly Prem. |
Dedu- ctible |
Additional Gap Coverage |
Preferred Pharmacy Copay/Coinsurance | Total Drugs | |||
---|---|---|---|---|---|---|---|---|
SilverScript SmartRx (PDP) (S5601-192) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$7.30 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 49% Specialty Tier: 25% | 3,564 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Wellness Rx (PDP) (S4802-186) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$14.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $6.00 Preferred Brand: $41.00 Non-Preferred Drug: 46% Specialty Tier: 25% select insulin pay $35 copay | 3,466 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Clear Spring Health Premier Rx (PDP) (S6946-043) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$15.40 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: 45% Specialty Tier: 25% | 3,276 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Value Script (PDP) (S4802-151) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$16.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $8.00 Preferred Brand: $43.00 Non-Preferred Drug: 48% Specialty Tier: 25% select insulin pay $35 copay | 3,466 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Walmart Value Rx Plan (PDP) (S5884-196) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$17.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 18% Non-Preferred Drug: 35% Specialty Tier: 25% | 3,175 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Medicare Rx Select (PDP) (S5810-291) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$20.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $47.00 Non-Preferred Drug: 42% Specialty Tier: 25% | 3,466 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Express Scripts Medicare - Value (PDP) (S5660-119) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.80 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $39.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00 | 3,033 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Mutual of Omaha Rx Premier (PDP) (S7126-086) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 23% Non-Preferred Drug: 45% Specialty Tier: 25% select insulin pay $25 copay | 2,943 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
AARP MedicareRx Saver Plus (PDP) (S5921-362) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.60 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $8.00 Preferred Brand: $37.00 Non-Preferred Drug: 40% Specialty Tier: 25% | 3,110 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure-Essential Rx (PDP) (S5617-296) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$24.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 18% Non-Preferred Drug: 50% Specialty Tier: 25% | 3,140 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Indy Health SaverRx (PDP) (S3535-011) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$24.50 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 25% | 3,219 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Clear Spring Health Value Rx (PDP) (S6946-014) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$24.50 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $45.00 Non-Preferred Drug: 37% Specialty Tier: 25% | 3,253 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
SilverScript Choice (PDP) (S5601-034) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$24.70 | $340 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 45% Specialty Tier: 26% | 3,014 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Classic (PDP) (S4802-087) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$25.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Drug: 35% Specialty Tier: 25% | 3,094 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Elixir RxPlus (PDP) (S7694-017) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$26.10 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $6.00 Preferred Brand: 15% Non-Preferred Drug: 25% Specialty Tier: 25% | 3,182 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Medicare Rx Saver (PDP) (S5810-051) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$26.60 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $36.00 Non-Preferred Drug: 41% Specialty Tier: 25% | 3,094 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure Rx (PDP) (S5617-224) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$26.80 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $37.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00 | 3,177 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Basic Rx Plan (PDP) (S5884-107) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$27.00 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 32% Specialty Tier: 25% | 3,074 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() |
A few notes to help with the understanding of the 2021 Medicare Part D Plan chart above.
Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information. Through the application process we will provide you with the most up-to-the-minute information/pricing. |