MedicarePartD.guide

A non-government resource built from CMS public data

VENLAFAXINE HYDROCHLORIDE 37.5 mg Tablet

Package: 100 TABLET in 1 BOTTLE (0093-9148-01). NDC 00093914801.

Plans covering it
367
across 39 regions checked
Lowest tier
2
lower tiers cost less
Plans with restrictions
80
prior auth, step therapy or quantity limit

Medicare Advantage plans in your county

Medicare Advantage drug plans in 51 states list this drug on their own formularies. Enter a ZIP code or choose a state to see every plan in a county, with its tier, cost-sharing and restrictions.

Coverage by region

Covered by at least one plan in 39 of 39 CMS regions.

RegionPlans coveringTiersLowest 30-day costRestrictions
New Jersey12 of 122–3$0.004 of 12 plans
Pennsylvania and West Virginia12 of 122–3$0.002 of 12 plans
North Carolina12 of 122–3$0.004 of 12 plans
Alabama and Tennessee12 of 122–3$0.004 of 12 plans
Michigan12 of 122–3$0.002 of 12 plans
Illinois12 of 122–3$0.004 of 12 plans
Arkansas12 of 122–3$0.002 of 12 plans
Texas12 of 122–3$0.004 of 12 plans
Kansas12 of 122–3$0.004 of 12 plans
California12 of 122–3$0.002 of 12 plans
Connecticut, Massachusetts, Rhode Island and Vermont11 of 112–3$0.001 of 11 plans
South Carolina11 of 112–3$0.002 of 11 plans
Oklahoma11 of 112–3$0.004 of 11 plans
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming11 of 112–3$0.003 of 11 plans
New Mexico11 of 112–3$0.003 of 11 plans
New York10 of 102–3$0.002 of 10 plans
Delaware, DC and Maryland10 of 102–3$0.002 of 10 plans
Georgia10 of 102–3$0.002 of 10 plans
Florida10 of 102–3$0.002 of 10 plans
Ohio10 of 102–3$0.002 of 10 plans
Indiana and Kentucky10 of 102–3$0.002 of 10 plans
Wisconsin10 of 102–3$0.002 of 10 plans
Missouri10 of 102–3$0.002 of 10 plans
Mississippi10 of 102–3$0.002 of 10 plans
Louisiana10 of 102–3$0.002 of 10 plans
Colorado10 of 102–3$0.002 of 10 plans
Arizona10 of 102–3$0.002 of 10 plans
Nevada10 of 102–3$0.002 of 10 plans
Oregon and Washington10 of 102–3$0.002 of 10 plans
Idaho and Utah10 of 102–3$0.002 of 10 plans
Maine and New Hampshire9 of 92–3$0.001 of 9 plans
Virginia9 of 92–3$0.001 of 9 plans
Alaska9 of 92–3$0.001 of 9 plans
Hawaii8 of 82–3$0.00none
Puerto Rico3 of 32–3$2.002 of 3 plans
American Samoa1 of 13—none
Guam1 of 13—none
Northern Mariana Islands1 of 13—none
U.S. Virgin Islands1 of 13—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, 4 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1815—None
Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1437—None
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7121—None
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1837—None
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible3Preferred Brand16%16%$0.2952$2.669 units
  • Quantity limit 9 per 30 days
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2548$2.299 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1852—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1308—None
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1629$1.479 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1815—None
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2313—None
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible2Generic$6.00$9.00$0.2548$2.299 units
  • Quantity limit 9 per 30 days

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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1641—None
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1548—None
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6577—None
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1684—None
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.2310—None
AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible3Preferred Brand16%16%$0.1128—None
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2197$1.989 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1647$1.489 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible3Preferred Brand16%16%$0.1170—None
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1641—None
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible2Generic$5.00$12.50$0.2319—None
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible2Generic25%25%$0.2319—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, 4 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1598—None
Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6629—None
Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1733—None
Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1778—None
AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1050—None
HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3336$3.009 units
  • Quantity limit 9 per 30 days
Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible3Preferred Brand20%20%$0.2561$2.309 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1585—None
HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1842$1.669 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1733—None
AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1050—None
Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible2Generic$6.00$18.00$0.2561$2.309 units
  • Quantity limit 9 per 30 days

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, 4 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1658—None
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1663—None
Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6240—None
Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1712—None
AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1107—None
BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible3Preferred Brand19%19%$0.2696$2.439 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3672$3.309 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1949$1.759 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1438—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1658—None
AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1109—None
BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible2Generic$12.00$24.00$0.2696$2.439 units
  • Quantity limit 9 per 30 days

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 — 12 plans, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1613—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1800$1.629 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1622—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.1652—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6790—None
AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1167—None
HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3246$2.929 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1335—None
AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible3Preferred Brand18%18%$0.1208—None
Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible2Generic$5.00$15.00$0.0881—None
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1622—None
Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible2Generic$5.00$10.00$0.0881—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, 4 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1405—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1666—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.1697—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7960—None
AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1165—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.4207$3.799 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible3Preferred Brand20%20%$0.2495$2.259 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1402—None
AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1233—None
HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1721$1.559 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1666—None
Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible2Generic$1.00$3.00$0.2419$2.189 units
  • Quantity limit 9 per 30 days

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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.2066—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2284$2.069 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1375—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.1461—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4429—None
BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible3Preferred Brand19%19%$0.1581—None
HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3947$3.559 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1102—None
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1399—None
Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1375—None
AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible3Preferred Brand16%16%$0.1102—None
BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible3Preferred Brand20%20%$0.1581—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, 4 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1538—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6955—None
Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1749—None
Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible2Generic$1.00$0.00$0.1694—None
HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3486$3.149 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1089—None
SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1657—None
Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.2518$2.279 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1791$1.619 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible3Preferred Brand18%18%$0.1089—None
Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1694—None
Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible2Generic$1.00$3.00$0.2664$2.409 units
  • Quantity limit 9 per 30 days

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, 4 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2803$2.529 units
  • Quantity limit 9 per 30 days
Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand18%18%$0.2900$2.619 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2061$1.859 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.2056—None
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6297—None
Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1482—None
Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1574—None
Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible2Generic$0.00$0.00$0.2900$2.619 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1858—None
AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1222—None
Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1482—None
AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible3Preferred Brand15%15%$0.1318—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1672$1.509 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1547—None
Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6774—None
HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2589$2.339 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1760—None
Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1803—None
AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1168—None
Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible2Generic$1.00$0.00$0.1779—None
AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible3Preferred Brand15%15%$0.1226—None
Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1779—None
Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.4078—None
Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible2Generic$7.00$14.00$0.4078—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, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1899—None
Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1415—None
Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand17%17%$0.2089—None
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7277—None
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.2500—None
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1516—None
Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1914—None
Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1899—None
HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1506$1.369 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible3Preferred Brand15%15%$0.1547—None
Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible3Preferred Brand$30.00$60.00$0.2089—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 — 11 plans, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1449—None
Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6767—None
Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$0.00$0.1778—None
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1820—None
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2751$2.489 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1911—None
AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1053—None
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1057—None
BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible2Generic$17.00$42.50$0.1916—None
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1778—None
HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1672$1.509 units
  • Quantity limit 9 per 30 days

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, 4 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$0.00$0.1547—None
Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand16%16%$0.2551$2.309 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.2183—None
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.5051—None
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1653—None
HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.4568$4.119 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1055—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1547—None
AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible3Preferred Brand16%16%$0.1058—None
HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2428$2.199 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible2Generic$1.00$3.00$0.2740$2.479 units
  • Quantity limit 9 per 30 days

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, 3 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1508—None
AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand17%17%$0.1136—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1888—None
Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7244—None
Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1550—None
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.2352—None
HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3278$2.959 units
  • Quantity limit 9 per 30 days
MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible3Preferred Brand22%22%$0.2816$2.539 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1508—None
HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1898$1.719 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible3Preferred Brand18%18%$0.1139—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, 3 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1645—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2073$1.879 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1790—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7354—None
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand16%16%$0.1182—None
Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1854—None
Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1790—None
AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible3Preferred Brand16%16%$0.1229—None
SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1290—None
Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible2Generic$4.00$12.00$0.2444$2.209 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2460$2.219 units
  • Quantity limit 9 per 30 days

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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1694$1.529 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1523—None
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6313—None
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2540$2.299 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1158—None
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1454—None
Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible2Generic$1.00$0.00$0.1630—None
Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1648—None
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible3Preferred Brand15%15%$0.1215—None
Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1630—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1727—None
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1749—None
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1399—None
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7349—None
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1695$1.539 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1148—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2977$2.689 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1201—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1392—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1727—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1659—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1597—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6645—None
Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1642—None
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3052$2.759 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1081—None
SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1565—None
Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1597—None
AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible3Preferred Brand16%16%$0.1083—None
HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1937$1.749 units
  • Quantity limit 9 per 30 days

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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1456—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7448—None
Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1888—None
Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible2Generic$1.00$0.00$0.1858—None
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1382—None
BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible3Preferred Brand20%20%$0.2332$2.109 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1105—None
Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1858—None
AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1125—None
BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible2Generic$3.00$9.00$0.2332$2.109 units
  • Quantity limit 9 per 30 days

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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1578—None
Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1585—None
Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6971—None
Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1626—None
HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2763$2.499 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1101—None
SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1634—None
HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1734$1.569 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1578—None
AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1116—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1581—None
Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1761—None
Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6080—None
Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1629—None
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.2215—None
HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3162$2.859 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1232—None
HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1908$1.729 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1581—None
AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible3Preferred Brand18%18%$0.1232—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1753—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2033$1.839 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1760—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.1823—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6600—None
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand17%17%$0.1045—None
SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible2Generic$10.00$30.00$0.2336—None
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible3Preferred Brand17%17%$0.4649$4.189 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1760—None
AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible3Preferred Brand15%15%$0.1045—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1956—None
Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.5803—None
Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1667—None
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1763—None
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.4062$3.669 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1141—None
HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2114$1.909 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1793—None
AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1193—None
Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1667—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1736—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1618—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.5959—None
Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1677—None
HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2000$1.809 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3949$3.559 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1154—None
Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1618—None
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1375—None
AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible3Preferred Brand16%16%$0.1209—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1607—None
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1829—None
Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.5140—None
Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1669—None
AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible3Preferred Brand16%16%$0.1098—None
SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible2Generic$10.00$30.00$0.1998—None
HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2086$1.889 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3672$3.309 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1607—None
AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible3Preferred Brand15%15%$0.1110—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1536—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1554—None
Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7031—None
Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1616—None
HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1911$1.729 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.4018$3.629 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1552—None
AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible3Preferred Brand19%19%$0.1053—None
Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1554—None
AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1053—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1634—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1833$1.659 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$0.00$0.1827—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7636—None
Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1884—None
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1099—None
HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.4181$3.769 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1674—None
AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible3Preferred Brand18%18%$0.1114—None
Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1827—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1869—None
Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1369—None
Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.8030—None
Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1898—None
HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3401$3.069 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.1062—None
HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1635$1.479 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1632—None
AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible3Preferred Brand18%18%$0.1076—None
Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1869—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1689—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1936$1.749 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1445—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7039—None
Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1484—None
AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1175—None
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible3Preferred Brand16%16%$0.3607$3.259 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1406—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1445—None
AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible3Preferred Brand16%16%$0.1218—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1475—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1705—None
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1528—None
Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6172—None
SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.2325—None
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible3Preferred Brand17%17%$0.3809$3.439 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1093—None
Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1475—None
HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2043$1.849 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1093—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, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1901—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2261$2.039 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1608—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7363—None
Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1669—None
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1063—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1599—None
AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible3Preferred Brand15%15%$0.1063—None
Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1608—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, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$9.00$0.1968—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1717—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.1782—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.6912—None
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.1088—None
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1792—None
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1717—None
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1093—None
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2196$1.989 units
  • Quantity limit 9 per 30 days

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, 1 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1831$1.659 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$0.00$0.1290—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7887—None
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1294—None
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1386—None
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible3Preferred Brand19%19%$0.2358—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0934—None
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible3Preferred Brand18%18%$0.2868—None
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1290—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
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand16%16%$0.1056—None
Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$4.00$0.00$0.1847—None
SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.2648—None
Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible2Generic$3.00$9.00$0.2536—None
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.7225—None
Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1863—None
Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1847—None
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible3Preferred Brand17%17%$0.1062—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible3Preferred Brand17%17%$0.4659$4.199 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2031$1.839 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible3Preferred Brand25%25%$0.0999—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
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.2418—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
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.2418—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
Prior authorization
Step therapy
Quantity limit

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$32.10/mo premium · $615.00 deductible3Preferred Brand25%25%$0.2418—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
Prior authorization
Step therapy
Quantity limit

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible3Preferred Brand25%25%$0.1074—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.