SYNTHROID 137 ug Tablet
Also known as Levothyroxine Sodium. Package: 90 TABLET in 1 BOTTLE (0074-3727-90). NDC 00074372790.
- Plans covering it
- 364
- across 39 regions checked
- Lowest tier
- 3
- lower tiers cost less
- Plans with restrictions
- 0
- prior auth, step therapy or quantity limit
Coverage by region
Covered by at least one plan in 39 of 39 CMS regions.
| Region | Plans covering | Tiers | Lowest 30-day cost | Restrictions |
|---|---|---|---|---|
| New Jersey | 12 of 12 | 3–4 | $45.00 | none |
| Pennsylvania and West Virginia | 12 of 12 | 3–4 | $45.00 | none |
| North Carolina | 12 of 12 | 3–4 | $45.00 | none |
| Alabama and Tennessee | 12 of 12 | 3–4 | $45.00 | none |
| Illinois | 12 of 12 | 3–4 | $45.00 | none |
| Arkansas | 12 of 12 | 3–4 | $45.00 | none |
| Texas | 12 of 12 | 3–4 | $45.00 | none |
| Kansas | 12 of 12 | 3–4 | $45.00 | none |
| California | 12 of 12 | 3–4 | $45.00 | none |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 3–4 | $45.00 | none |
| Oklahoma | 11 of 11 | 3–4 | $45.00 | none |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 3–4 | $45.00 | none |
| New Mexico | 11 of 11 | 3–4 | $45.00 | none |
| New York | 10 of 10 | 3–4 | $45.00 | none |
| Delaware, DC and Maryland | 10 of 10 | 3–4 | $45.00 | none |
| South Carolina | 10 of 11 | 3–4 | $45.00 | none |
| Georgia | 10 of 10 | 3–4 | $45.00 | none |
| Florida | 10 of 10 | 3–4 | $45.00 | none |
| Michigan | 10 of 12 | 3–4 | $45.00 | none |
| Ohio | 10 of 10 | 3–4 | $45.00 | none |
| Indiana and Kentucky | 10 of 10 | 3–4 | $45.00 | none |
| Wisconsin | 10 of 10 | 3–4 | $45.00 | none |
| Missouri | 10 of 10 | 3–4 | $45.00 | none |
| Mississippi | 10 of 10 | 3–4 | $45.00 | none |
| Louisiana | 10 of 10 | 3–4 | $45.00 | none |
| Colorado | 10 of 10 | 3–4 | $45.00 | none |
| Arizona | 10 of 10 | 3–4 | $45.00 | none |
| Nevada | 10 of 10 | 3–4 | $45.00 | none |
| Oregon and Washington | 10 of 10 | 3–4 | $45.00 | none |
| Idaho and Utah | 10 of 10 | 3–4 | $45.00 | none |
| Maine and New Hampshire | 9 of 9 | 3–4 | $45.00 | none |
| Virginia | 9 of 9 | 3–4 | $45.00 | none |
| Alaska | 9 of 9 | 3–4 | $45.00 | none |
| Hawaii | 8 of 8 | 3–4 | $45.00 | none |
| Puerto Rico | 3 of 3 | 3–4 | — | none |
| American Samoa | 1 of 1 | 3 | — | none |
| Guam | 1 of 1 | 3 | — | none |
| Northern Mariana Islands | 1 of 1 | 3 | — | none |
| U.S. Virgin Islands | 1 of 1 | 3 | — | none |
Plan-by-plan detail
Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.
New Jersey — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6710 | — | None |
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 3Preferred Brand | 19% | 14% | $1.6710 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7662 | — | None |
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6710 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7662 | — | None |
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 3Preferred Brand | 20% | 20% | $1.7481 | — | None |
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.5905 | — | None |
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.5905 | — | None |
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6444 | — | None |
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 45% | 45% | $1.7481 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6906 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6446 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Pennsylvania and West Virginia — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6692 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6692 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $1.7603 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $1.7603 | — | None |
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6692 | — | None |
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 3Preferred Brand | 25% | 25% | $1.6601 | — | None |
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.6504 | — | None |
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6028 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.6028 | — | None |
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6906 | — | None |
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6492 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6499 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
North Carolina — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6730 | — | None |
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6730 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7711 | — | None |
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6730 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7711 | — | None |
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $135.00 | $1.7976 | — | None |
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6153 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6153 | — | None |
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6629 | — | None |
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.7976 | — | None |
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6911 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6657 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Alabama and Tennessee — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6691 | — | None |
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6691 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7755 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6691 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7755 | — | None |
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6166 | — | None |
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6166 | — | None |
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 41% | 41% | $1.7835 | — | None |
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6491 | — | None |
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6543 | — | None |
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6909 | — | None |
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 4Non-Preferred Drug | 42% | 42% | $1.7835 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Illinois — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6940 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6940 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7901 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7901 | — | None |
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6940 | — | None |
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7488 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6149 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6149 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6558 | — | None |
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 43% | 43% | $1.7724 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6912 | — | None |
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6578 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Arkansas — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6603 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6603 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7782 | — | None |
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6603 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $1.7782 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $1.6148 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6148 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6391 | — | None |
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | 34% | $1.6896 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6348 | — | None |
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6918 | — | None |
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 34% | 34% | $1.6896 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Texas — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6676 | — | None |
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6676 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7786 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $1.7786 | — | None |
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6676 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7444 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6099 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6099 | — | None |
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6498 | — | None |
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6910 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 42% | 42% | $1.7717 | — | None |
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6514 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Kansas — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6734 | — | None |
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6734 | — | None |
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 3Preferred Brand | 20% | 20% | $1.8019 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7742 | — | None |
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6734 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7742 | — | None |
| Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.8035 | — | None |
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.8019 | — | None |
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6891 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6654 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $1.6654 | — | None |
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.7024 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
California — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $1.6766 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7623 | — | None |
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6766 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7623 | — | None |
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6766 | — | None |
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 3Preferred Brand | 19% | 19% | $1.7097 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6575 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6025 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6025 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6573 | — | None |
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6911 | — | None |
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 49% | 49% | $1.7097 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Connecticut, Massachusetts, Rhode Island and Vermont — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6812 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7611 | — | None |
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $1.6812 | — | None |
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6812 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7611 | — | None |
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.5988 | — | None |
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6599 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.5988 | — | None |
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6906 | — | None |
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6713 | — | None |
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6599 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oklahoma — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6476 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6476 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7224 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6476 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $1.7224 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7695 | — | None |
| Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.7734 | — | None |
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.8475 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $1.8475 | — | None |
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.8635 | — | None |
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.8636 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6692 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7656 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6692 | — | None |
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6692 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $1.7656 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6560 | — | None |
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6560 | — | None |
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6986 | — | None |
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6642 | — | None |
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 42% | 42% | $1.7951 | — | None |
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6646 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
New Mexico — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6743 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $1.7875 | — | None |
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6743 | — | None |
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6743 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $1.7875 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6626 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6626 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.7004 | — | None |
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6906 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.7585 | — | None |
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.7908 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
New York — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7618 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6646 | — | None |
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 3Preferred Brand | 17% | 12% | $1.6646 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7618 | — | None |
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6646 | — | None |
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6341 | — | None |
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.5904 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.5904 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6344 | — | None |
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6910 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Delaware, DC and Maryland — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6742 | — | None |
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6742 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7671 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7671 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6742 | — | None |
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6003 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6003 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6536 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6527 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6906 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
South Carolina — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6746 | — | None |
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 3Preferred Brand | 19% | 14% | $1.6746 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7701 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7701 | — | None |
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6746 | — | None |
| Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6067 | — | None |
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6067 | — | None |
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6544 | — | None |
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6916 | — | None |
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6585 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Georgia — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6732 | — | None |
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6732 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7671 | — | None |
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6732 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $1.7671 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.6184 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6184 | — | None |
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6436 | — | None |
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6914 | — | None |
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6524 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Florida — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6793 | — | None |
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6793 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7757 | — | None |
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6793 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7757 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.6057 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6057 | — | None |
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6906 | — | None |
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.8098 | — | None |
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.8098 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Michigan — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6759 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6759 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7742 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $1.7742 | — | None |
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6759 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.6151 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6151 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6496 | — | None |
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6459 | — | None |
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6913 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Ohio — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6740 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6740 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7584 | — | None |
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6740 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7584 | — | None |
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6259 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6259 | — | None |
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6538 | — | None |
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6908 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6594 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Indiana and Kentucky — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6777 | — | None |
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6777 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7765 | — | None |
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6777 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $1.7765 | — | None |
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6217 | — | None |
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6217 | — | None |
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6906 | — | None |
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6600 | — | None |
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6645 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Wisconsin — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6627 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6627 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7910 | — | None |
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6627 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7910 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $1.6203 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6203 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6488 | — | None |
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6915 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6473 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Missouri — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6696 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6696 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7820 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7820 | — | None |
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6696 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6114 | — | None |
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $1.6114 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6512 | — | None |
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6512 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6924 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Mississippi — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6628 | — | None |
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6628 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7810 | — | None |
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6628 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $1.7810 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6204 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6204 | — | None |
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6439 | — | None |
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6402 | — | None |
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6923 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Louisiana — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6674 | — | None |
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6674 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $1.7864 | — | None |
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6674 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7864 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.5982 | — | None |
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.5982 | — | None |
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6919 | — | None |
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6410 | — | None |
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6407 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Colorado — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6752 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6752 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $1.7820 | — | None |
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6752 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7820 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6517 | — | None |
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6517 | — | None |
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6654 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6573 | — | None |
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6927 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Arizona — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 23% | 18% | $1.6760 | — | None |
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6760 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $1.7618 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $1.7618 | — | None |
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6760 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $1.6396 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6396 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.6769 | — | None |
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6744 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6914 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Nevada — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6776 | — | None |
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $1.6776 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $1.7755 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $1.7755 | — | None |
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6776 | — | None |
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6177 | — | None |
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6177 | — | None |
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6613 | — | None |
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6648 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6906 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oregon and Washington — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6686 | — | None |
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6686 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7727 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6686 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $1.7727 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.6416 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6416 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6551 | — | None |
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6508 | — | None |
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6929 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Idaho and Utah — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6618 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6618 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7688 | — | None |
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6618 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7688 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6138 | — | None |
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6138 | — | None |
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6927 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6220 | — | None |
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6264 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Maine and New Hampshire — 9 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6715 | — | None |
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6715 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7728 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $1.7728 | — | None |
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6715 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $1.6132 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6132 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1.6581 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6906 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Virginia — 9 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $1.6764 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6764 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $1.7667 | — | None |
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6764 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7667 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6110 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.6110 | — | None |
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.6913 | — | None |
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6606 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Alaska — 9 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 24% | 19% | $1.6723 | — | None |
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6723 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $1.7468 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $1.7468 | — | None |
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6723 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $1.7420 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $1.7413 | — | None |
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.7420 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.7013 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Hawaii — 8 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $1.7573 | — | None |
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 3Preferred Brand | 23% | 18% | $1.6917 | — | None |
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $1.6917 | — | None |
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $1.6917 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $1.7573 | — | None |
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.6936 | — | None |
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $1.5985 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $1.5985 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Puerto Rico — 3 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.7584 | — | None |
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $1.6095 | — | None |
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | 34% | $1.6095 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
American Samoa — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.8166 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Guam — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.8166 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Northern Mariana Islands — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$32.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.8166 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
U.S. Virgin Islands — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $2.0557 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.