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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) (S5601-200) 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: 46% 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 | |||
---|---|---|---|---|---|---|---|---|
SilverScript Plus (PDP) (S5601-051) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$70.20 | $0 | Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33% | 3,060 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) (S5601-050) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$33.90 | $240 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 46% Specialty Tier: 28% | 174,870 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
MedicareBlue Rx Standard (PDP) (S5743-001) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$66.40 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: $29.00 Non-Preferred Drug: 31% Specialty Tier: 25% | 157,419 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Walmart Value Rx Plan (PDP) (S5884-204) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$17.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 16% Non-Preferred Drug: 35% Specialty Tier: 25% | 117,736 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Wellness Rx (PDP) (S4802-194) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$15.30 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Drug: 47% Specialty Tier: 25% | 114,323 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Humana Premier Rx Plan (PDP) (S5884-171) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$60.80 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Drug: 49% Specialty Tier: 25% | 92,630 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) (S5601-200) 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: 46% Specialty Tier: 25% | 3,564 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Clear Spring Health Premier Rx (PDP) (S6946-051) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$14.30 | $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 Wellness Rx (PDP) (S4802-194) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$15.30 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $4.00 Preferred Brand: $40.00 Non-Preferred Drug: 47% Specialty Tier: 25% select insulin pay $35 copay | 3,466 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Value Script (PDP) (S4802-158) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$15.70 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $43.00 Non-Preferred Drug: 47% 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) (S5884-204) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$17.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 16% Non-Preferred Drug: 35% Specialty Tier: 25% | 3,175 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Cigna Secure-Essential Rx (PDP) (S5617-304) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$22.90 | $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: ![]() | ||||||||
Mutual of Omaha Rx Premier (PDP) (S7126-094) 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: 46% Specialty Tier: 25% select insulin pay $25 copay | 2,943 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Medicare Rx Select (PDP) (S5810-302) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$23.40 | $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 - Saver (PDP) (S5660-241) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$25.20 | $285 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Drug: 50% Specialty Tier: 28% select insulin pay $35 copay | 2,951 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
WellCare Classic (PDP) (S4802-089) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$28.20 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $31.00 Non-Preferred Drug: 33% Specialty Tier: 25% | 3,094 Browse Formulary | |||
Higher cost-sharing at non-preferred pharmacies. Click for details: ![]() | ||||||||
Clear Spring Health Value Rx (PDP) (S6946-022) Benefits & Contact Info ![]() ![]() ![]() ![]() |
$29.30 | $445 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $42.00 Non-Preferred Drug: 34% Specialty Tier: 25% | 3,253 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. |