XIGDUO XR 10/500 mg Tablet, Film Coated, Extended Release
Also known as Dapagliflozin And Metformin Hydrochloride. Package: 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC (0310-6270-30). NDC 00310627030.
- Plans covering it
- 265
- across 39 regions checked
- Lowest tier
- 3
- lower tiers cost less
- Plans with restrictions
- 264
- 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 | 9 of 12 | 3 | — | 9 of 9 plans |
| Pennsylvania and West Virginia | 9 of 12 | 3 | — | 9 of 9 plans |
| North Carolina | 9 of 12 | 3 | $45.00 | 9 of 9 plans |
| Alabama and Tennessee | 9 of 12 | 3 | $47.00 | 9 of 9 plans |
| Michigan | 9 of 12 | 3 | — | 9 of 9 plans |
| Illinois | 9 of 12 | 3 | — | 9 of 9 plans |
| Arkansas | 9 of 12 | 3 | — | 9 of 9 plans |
| Texas | 9 of 12 | 3 | — | 9 of 9 plans |
| Kansas | 9 of 12 | 3 | — | 9 of 9 plans |
| California | 9 of 12 | 3 | — | 9 of 9 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 8 of 11 | 3 | $30.00 | 8 of 8 plans |
| South Carolina | 8 of 11 | 3 | — | 7 of 8 plans |
| Oklahoma | 8 of 11 | 3 | — | 8 of 8 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 8 of 11 | 3 | — | 8 of 8 plans |
| New Mexico | 8 of 11 | 3 | — | 8 of 8 plans |
| New York | 7 of 10 | 3 | — | 7 of 7 plans |
| Delaware, DC and Maryland | 7 of 10 | 3 | — | 7 of 7 plans |
| Georgia | 7 of 10 | 3 | — | 7 of 7 plans |
| Florida | 7 of 10 | 3 | — | 7 of 7 plans |
| Ohio | 7 of 10 | 3 | — | 7 of 7 plans |
| Indiana and Kentucky | 7 of 10 | 3 | — | 7 of 7 plans |
| Wisconsin | 7 of 10 | 3 | — | 7 of 7 plans |
| Missouri | 7 of 10 | 3 | — | 7 of 7 plans |
| Mississippi | 7 of 10 | 3 | — | 7 of 7 plans |
| Louisiana | 7 of 10 | 3 | — | 7 of 7 plans |
| Colorado | 7 of 10 | 3 | — | 7 of 7 plans |
| Arizona | 7 of 10 | 3 | — | 7 of 7 plans |
| Nevada | 7 of 10 | 3 | — | 7 of 7 plans |
| Oregon and Washington | 7 of 10 | 3 | — | 7 of 7 plans |
| Idaho and Utah | 7 of 10 | 3 | — | 7 of 7 plans |
| Maine and New Hampshire | 6 of 9 | 3 | — | 6 of 6 plans |
| Virginia | 6 of 9 | 3 | — | 6 of 6 plans |
| Alaska | 6 of 9 | 3 | — | 6 of 6 plans |
| Hawaii | 5 of 8 | 3 | — | 5 of 5 plans |
| Puerto Rico | 3 of 3 | 3 | — | 3 of 3 plans |
| American Samoa | 1 of 1 | 3 | — | 1 of 1 plans |
| Guam | 1 of 1 | 3 | — | 1 of 1 plans |
| Northern Mariana Islands | 1 of 1 | 3 | — | 1 of 1 plans |
| U.S. Virgin Islands | 1 of 1 | 3 | — | 1 of 1 plans |
Plan-by-plan detail
Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.
New Jersey — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.0920 | $54.283 units |
|
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.0920 | $54.283 units |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $18.5686 | $55.713 units |
|
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.8217 | $59.473 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.2235 | $60.673 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $18.5679 | $55.703 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $20.2235 | $60.673 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 3Preferred Brand | 20% | 20% | $19.8217 | $59.473 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2357 | $54.713 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2357 | $54.713 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $20.2597 | $60.783 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.8650 | $56.593 units |
|
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.8598 | $56.583 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $20.2597 | $60.783 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 3Preferred Brand | 25% | 25% | $18.9819 | $569.4630 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.8897 | $566.6930 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4071 | $55.223 units |
|
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4071 | $55.223 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.4430 | $61.333 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.9321 | $56.803 units |
|
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $20.5501 | $61.653 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4392 | $58.323 units |
|
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $18.9340 | $56.803 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.4430 | $61.333 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $135.00 | $20.5501 | $61.653 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4922 | $55.483 units |
|
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4922 | $55.483 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.5463 | $61.643 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $20.5913 | $61.773 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.8910 | $56.673 units |
|
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $18.9344 | $56.803 units |
|
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4440 | $58.333 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.5463 | $61.643 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 3Preferred Brand | $47.00 | $94.00 | $20.5913 | $61.773 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3226 | $54.973 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3226 | $54.973 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.7239 | $56.173 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.2343 | $60.703 units |
|
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.7043 | $56.113 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.2343 | $60.703 units |
|
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $19.1018 | $57.313 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 3Preferred Brand | 24% | 24% | $19.1018 | $57.313 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3733 | $55.123 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3733 | $55.123 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.7138 | $62.143 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.9346 | $56.803 units |
|
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $20.3609 | $61.083 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4331 | $58.303 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.7138 | $62.143 units |
|
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.9288 | $56.793 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.0179 | $60.053 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $17.8346 | $53.503 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $17.8346 | $53.503 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.1267 | $54.383 units |
|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4069 | $58.223 units |
|
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.0390 | $54.123 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.3013 | $60.903 units |
|
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $20.3013 | $60.903 units |
|
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 3Preferred Brand | 20% | 20% | $19.4069 | $58.223 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3467 | $55.043 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3467 | $55.043 units |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.8576 | $56.573 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.4863 | $61.463 units |
|
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4320 | $58.303 units |
|
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $20.2842 | $60.853 units |
|
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.8568 | $56.573 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.4863 | $61.463 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.9750 | $59.933 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $20.2775 | $60.833 units |
|
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.2682 | $60.803 units |
|
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.9602 | $56.883 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.7432 | $56.233 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.7432 | $56.233 units |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 3Preferred Brand | 20% | 20% | $20.2682 | $60.803 units |
|
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.5666 | $58.703 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.2492 | $60.753 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $20.2492 | $60.753 units |
|
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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.7537 | $56.263 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2715 | $54.813 units |
|
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2715 | $54.813 units |
|
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.7565 | $56.273 units |
|
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.2554 | $60.773 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $20.2554 | $60.773 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.5414 | $586.2430 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 3Preferred Brand | 19% | 19% | $19.5414 | $586.2430 units |
|
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 — 8 plans, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.1502 | $54.453 units |
|
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $19.0806 | $57.243 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.1502 | $54.453 units |
|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.1795 | $60.543 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.8691 | $56.613 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $20.1795 | $60.543 units |
|
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 3Preferred Brand | $30.00 | $60.00 | $19.0806 | $57.243 units |
|
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 — 8 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3530 | $55.063 units |
|
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3530 | $55.063 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.8315 | $56.493 units |
|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.2935 | $60.883 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.2935 | $60.883 units |
|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $19.2478 | — | None |
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.8704 | $56.613 units |
|
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 — 8 plans, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $20.0240 | $60.073 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5745 | $55.723 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5745 | $55.723 units |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.9384 | $56.823 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.5714 | $61.713 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $20.5714 | $61.713 units |
|
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $18.9337 | $56.803 units |
|
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.0095 | $60.033 units |
|
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 — 8 plans, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.4021 | $61.213 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6470 | $55.943 units |
|
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6470 | $55.943 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.5263 | $58.583 units |
|
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $19.0660 | $57.203 units |
|
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $21.1924 | $63.583 units |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $19.0659 | $57.203 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.4021 | $61.213 units |
|
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 — 8 plans, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5842 | $55.753 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5842 | $55.753 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $19.0989 | $57.303 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $21.1502 | $63.453 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $21.1502 | $63.453 units |
|
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 3Preferred Brand | 14% | 14% | $20.4120 | $61.243 units |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $21.1875 | $63.563 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.1799 | $54.543 units |
|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $17.9819 | $53.953 units |
|
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $17.9819 | $53.953 units |
|
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.1823 | $54.553 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.1546 | $60.463 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4311 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $20.1546 | $60.463 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2801 | $54.843 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2801 | $54.843 units |
|
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $18.6985 | $56.103 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.2254 | $60.683 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.7048 | $56.113 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.2254 | $60.683 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5487 | $55.653 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5487 | $55.653 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.7901 | $56.373 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.3364 | $61.013 units |
|
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.5059 | $58.523 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $20.3364 | $61.013 units |
|
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.8812 | $56.643 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3496 | $55.053 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.3496 | $55.053 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $20.7252 | $62.183 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.5195 | $61.563 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.5195 | $61.563 units |
|
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.7252 | $62.183 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5293 | $55.593 units |
|
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5293 | $55.593 units |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.8237 | $56.473 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.2231 | $60.673 units |
|
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.8869 | $56.663 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.2231 | $60.673 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6090 | $55.833 units |
|
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6090 | $55.833 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4750 | $58.433 units |
|
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $19.0227 | $57.073 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.4037 | $61.213 units |
|
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $19.0588 | $57.183 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.4037 | $61.213 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5919 | $55.783 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5919 | $55.783 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.8675 | $56.603 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $21.1170 | $63.353 units |
|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4309 | $58.293 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.8847 | $56.653 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $21.1170 | $63.353 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6385 | $55.923 units |
|
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6385 | $55.923 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.8210 | $56.463 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.5779 | $61.733 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $18.8194 | $56.463 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4415 | $58.323 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.5779 | $61.733 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5360 | $55.613 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5360 | $55.613 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.7513 | $56.253 units |
|
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.7103 | $56.133 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.3506 | $61.053 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4313 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $20.3506 | $61.053 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.0727 | $54.223 units |
|
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.0727 | $54.223 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $20.5788 | $61.743 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4321 | $58.303 units |
|
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $18.4903 | $55.473 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.4927 | $55.483 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $20.5788 | $61.743 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.9829 | $56.953 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.9829 | $56.953 units |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $19.3912 | $58.173 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $19.3456 | $58.043 units |
|
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.7099 | $59.133 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $21.0316 | $63.093 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $21.0316 | $63.093 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6863 | $56.063 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6863 | $56.063 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $19.1056 | $57.323 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $20.3422 | $61.033 units |
|
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $19.0825 | $57.253 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.3422 | $61.033 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5858 | $55.763 units |
|
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5858 | $55.763 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $19.1533 | $57.463 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $20.7198 | $62.163 units |
|
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $19.1792 | $57.543 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.7198 | $62.163 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4358 | $55.313 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4358 | $55.313 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 24% | 24% | $18.5575 | $55.673 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.2987 | $60.903 units |
|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $18.5761 | $55.733 units |
|
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.5748 | $58.723 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $20.2987 | $60.903 units |
|
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 — 7 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6027 | $55.813 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.6027 | $55.813 units |
|
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4309 | $58.293 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.7167 | $56.153 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.4541 | $61.363 units |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $18.7902 | $56.373 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.4541 | $61.363 units |
|
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 — 6 plans, 6 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5100 | $55.533 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.5100 | $55.533 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.8300 | $56.493 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $21.2302 | $63.693 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.6365 | $58.913 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $21.2302 | $63.693 units |
|
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 — 6 plans, 6 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4647 | $55.393 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.4647 | $55.393 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $20.3884 | $61.173 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.3884 | $61.173 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $19.0604 | $57.183 units |
|
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 — 6 plans, 6 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.7814 | $56.343 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.8141 | $56.443 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.7814 | $56.343 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $20.2434 | $60.733 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $19.4309 | $58.293 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $20.2434 | $60.733 units |
|
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 — 5 plans, 5 with restrictions
| 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% | $20.5791 | $61.743 units |
|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $19.4309 | $58.293 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2056 | $54.623 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $18.2056 | $54.623 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $20.5791 | $61.743 units |
|
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, 3 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $18.3436 | $55.033 units |
|
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $18.3353 | $55.013 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $20.2116 | $60.633 units |
|
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, 1 with restrictions
| 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% | $20.8776 | $62.633 units |
|
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, 1 with restrictions
| 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% | $20.8776 | $62.633 units |
|
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, 1 with restrictions
| 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% | $20.8776 | $62.633 units |
|
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, 1 with restrictions
| 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% | $20.8776 | $62.633 units |
|
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.