ACETAMINOPHEN AND CODEINE PHOSPHATE 300/15 mg Tablet
Package: 100 TABLET in 1 BOTTLE (13107-058-01). NDC 13107005801.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 2
- lower tiers cost less
- Plans with restrictions
- 366
- prior auth, step therapy or quantity limit
Coverage by region
Covered by at least one plan in 39 of 39 CMS regions.
| Region | Plans covering | Tiers | Lowest 30-day cost | Restrictions |
|---|---|---|---|---|
| New Jersey | 12 of 12 | 3–4 | $45.00 | 12 of 12 plans |
| Pennsylvania and West Virginia | 12 of 12 | 2–4 | $5.00 | 12 of 12 plans |
| North Carolina | 12 of 12 | 3–4 | $45.00 | 12 of 12 plans |
| Alabama and Tennessee | 12 of 12 | 3–4 | $45.00 | 12 of 12 plans |
| Michigan | 12 of 12 | 3–4 | $45.00 | 12 of 12 plans |
| Illinois | 12 of 12 | 3–4 | $45.00 | 12 of 12 plans |
| Arkansas | 12 of 12 | 2–4 | $5.00 | 12 of 12 plans |
| Texas | 12 of 12 | 3–4 | $45.00 | 12 of 12 plans |
| Kansas | 12 of 12 | 3–4 | $45.00 | 12 of 12 plans |
| California | 12 of 12 | 2–4 | $7.00 | 12 of 12 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 2–4 | $3.00 | 11 of 11 plans |
| South Carolina | 11 of 11 | 2–4 | $17.00 | 10 of 11 plans |
| Oklahoma | 11 of 11 | 3–4 | $45.00 | 11 of 11 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 2–4 | $10.00 | 11 of 11 plans |
| New Mexico | 11 of 11 | 3–4 | $45.00 | 11 of 11 plans |
| New York | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Delaware, DC and Maryland | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Georgia | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Florida | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Ohio | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Indiana and Kentucky | 10 of 10 | 2–4 | $10.00 | 10 of 10 plans |
| Wisconsin | 10 of 10 | 2–4 | $10.00 | 10 of 10 plans |
| Missouri | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Mississippi | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Louisiana | 10 of 10 | 2–4 | $10.00 | 10 of 10 plans |
| Colorado | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Arizona | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Nevada | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Oregon and Washington | 10 of 10 | 3–4 | $45.00 | 10 of 10 plans |
| Idaho and Utah | 10 of 10 | 2–4 | $10.00 | 10 of 10 plans |
| Maine and New Hampshire | 9 of 9 | 3–4 | $45.00 | 9 of 9 plans |
| Virginia | 9 of 9 | 3–4 | $45.00 | 9 of 9 plans |
| Alaska | 9 of 9 | 3–4 | $45.00 | 9 of 9 plans |
| Hawaii | 8 of 8 | 2–4 | $10.00 | 8 of 8 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4281 | $16.7039 units |
|
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 3Preferred Brand | 19% | 14% | $0.4312 | $16.8239 units |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $0.4650 | $16.7436 units |
|
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3795 | $13.6636 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3110 | $5.6018 units |
|
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.5106 | $18.3836 units |
|
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4263 | $16.6339 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3176 | $12.3939 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 3Preferred Brand | 20% | 20% | $0.3795 | $13.6636 units |
|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4826 | $17.3736 units |
|
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $0.4547 | $16.3736 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.3417 | $13.3339 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2451 | $4.4118 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 2Generic | $5.00 | $12.50 | $0.3385 | $132.02390 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $0.3386 | $132.05390 units |
|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.3816 | $14.8839 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.3881 | $15.1439 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4378 | $15.7636 units |
|
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.5081 | $18.2936 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.3047 | $11.8839 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3781 | $14.7539 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4662 | $16.7836 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4413 | $15.8936 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 41% | — | $0.3401 | $13.2639 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4394 | $17.1439 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4450 | $17.3639 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.5030 | $18.1136 units |
|
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.3467 | $12.4836 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3116 | $5.6118 units |
|
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $0.5510 | $19.8436 units |
|
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4363 | $17.0239 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3163 | $12.3439 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $135.00 | $0.3467 | $12.4836 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5169 | $18.6136 units |
|
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4806 | $17.3036 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | — | $0.3355 | $13.0839 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4110 | $16.0339 units |
|
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4182 | $16.3139 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $0.3779 | $13.6036 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4845 | $17.4436 units |
|
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $0.5137 | $18.4936 units |
|
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3022 | $5.4418 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4070 | $15.8739 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3067 | $11.9639 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4933 | $17.7636 units |
|
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4584 | $16.5036 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.3380 | $13.1839 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 4Non-Preferred Drug | 42% | 42% | $0.3779 | $13.6036 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 — 12 plans, 12 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% | $0.4689 | $16.8836 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4174 | $16.2839 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4211 | $16.4239 units |
|
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4442 | $15.9936 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3183 | $5.7318 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.3055 | $11.9139 units |
|
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.2785 | $100.26360 units |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4153 | $16.2039 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 3Preferred Brand | 24% | 24% | $0.2785 | $100.26360 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4506 | $16.2236 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4740 | $17.0636 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $0.3395 | $13.2439 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4289 | $16.7339 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4339 | $16.9239 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4956 | $17.8436 units |
|
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.3770 | $13.5736 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3172 | $5.7118 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3155 | $12.3039 units |
|
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.5261 | $18.9436 units |
|
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4261 | $16.6239 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3611 | $13.0036 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.4772 | $17.1836 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5125 | $18.4536 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 39% | — | $0.3392 | $13.2339 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $0.1559 | $0.624 units |
|
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 2Generic | $5.00 | $15.00 | $0.1559 | $0.624 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.5126 | $18.4536 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.3876 | $15.1239 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4016 | $15.6639 units |
|
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.5028 | $18.1036 units |
|
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3294 | $5.9318 units |
|
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3798 | $14.8139 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.3066 | $11.9639 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $0.4400 | $15.8436 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4883 | $17.5836 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | — | $0.3374 | $13.1639 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4139 | $16.1439 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4065 | $15.8539 units |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4613 | $16.6136 units |
|
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3159 | $5.6918 units |
|
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $0.4271 | $15.3836 units |
|
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.4966 | $17.8836 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.3083 | $12.0239 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4024 | $15.6939 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.4247 | $15.2936 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $0.4487 | $16.1536 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4838 | $17.4236 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 38% | — | $0.3379 | $13.1839 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.4365 | $15.7136 units |
|
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.5002 | $18.0136 units |
|
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.3667 | $14.3039 units |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.3747 | $14.6139 units |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 3Preferred Brand | 20% | 20% | $0.4365 | $15.7136 units |
|
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3186 | $5.7318 units |
|
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3623 | $14.1339 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3155 | $12.3039 units |
|
| Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $0.4267 | $15.3636 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5089 | $18.3236 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $0.4754 | $17.1136 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 38% | — | $0.3434 | $13.3939 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 2Generic | $7.00 | $17.50 | $0.7315 | $263.34360 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 2Generic | $7.00 | $14.00 | $0.7315 | $263.34360 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.5274 | $18.9936 units |
|
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4308 | $15.5136 units |
|
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3141 | $5.6518 units |
|
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $0.4077 | $15.9039 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4051 | $15.8039 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3163 | $12.3439 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4036 | $15.7439 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4616 | $16.6236 units |
|
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.4323 | $15.5636 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 38% | — | $0.3368 | $13.1439 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 — 11 plans, 11 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $6.00 | $0.2365 | $0.954 units |
|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2418 | $4.3518 units |
|
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 2Generic | $7.00 | $14.00 | $0.2365 | $0.954 units |
|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4258 | $16.6139 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $0.4281 | $16.7039 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4245 | $16.5639 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.5370 | $19.3336 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3231 | $12.6039 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4879 | $17.5636 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $0.4548 | $16.3736 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.3406 | $13.2839 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 — 11 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 2Generic | $17.00 | $42.50 | $0.3074 | — | None |
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.3972 | $15.4939 units |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 3Preferred Brand | 19% | 14% | $0.4078 | $15.9039 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4857 | $17.4936 units |
|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3225 | $5.8018 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3094 | $12.0739 units |
|
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3914 | $15.2639 units |
|
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.5213 | $18.7736 units |
|
| Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4866 | $17.5236 units |
|
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4447 | $16.0136 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.3369 | $13.1439 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 — 11 plans, 11 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% | $0.4146 | $14.9336 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.3901 | $15.2139 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.3991 | $15.5639 units |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4715 | $16.9736 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3851 | $15.0239 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.2966 | $11.5739 units |
|
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.4876 | $17.5536 units |
|
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.4244 | $15.2836 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4702 | $16.9336 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $0.4379 | $15.7636 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 41% | — | $0.3394 | $13.2439 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 — 11 plans, 11 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2283 | $4.1118 units |
|
| Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.3872 | $15.1039 units |
|
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.3928 | $15.3239 units |
|
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4372 | $15.7436 units |
|
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $0.4148 | $14.9336 units |
|
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3841 | $14.9839 units |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.4460 | $16.0636 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.2943 | $11.4839 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.3425 | $13.3639 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4948 | $17.8136 units |
|
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4672 | $16.8236 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 — 11 plans, 11 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% | $0.5453 | $19.6336 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4620 | $18.0239 units |
|
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4675 | $18.2339 units |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4590 | $17.9039 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.3168 | $12.3639 units |
|
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3235 | $5.8218 units |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3793 | $13.6536 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.5052 | $18.1936 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5401 | $19.4436 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 43% | — | $0.3368 | $13.1439 units |
|
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.3618 | $13.0236 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 — 10 plans, 10 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% | $0.4683 | $16.8636 units |
|
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4355 | $15.6836 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3027 | $5.4518 units |
|
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4070 | $15.8739 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 3Preferred Brand | 17% | 12% | $0.4096 | $15.9739 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3016 | $11.7639 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4055 | $15.8139 units |
|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4489 | $16.1636 units |
|
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4274 | $15.3936 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 38% | — | $0.3410 | $13.3039 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4154 | $16.2039 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4213 | $16.4339 units |
|
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $0.5240 | $18.8636 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4724 | $17.0136 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3126 | $12.1939 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3248 | $5.8518 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4121 | $16.0739 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4879 | $17.5636 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.4532 | $16.3236 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.3375 | $13.1639 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4080 | $15.9139 units |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4144 | $16.1639 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4759 | $17.1336 units |
|
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3143 | $5.6618 units |
|
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4044 | $15.7739 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.3066 | $11.9639 units |
|
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.5042 | $18.1536 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4532 | $16.3236 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4835 | $17.4136 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.3374 | $13.1639 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4221 | $16.4639 units |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4183 | $16.3139 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3125 | $5.6218 units |
|
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.3233 | $11.6436 units |
|
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4162 | $16.2339 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3065 | $11.9539 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4477 | $16.1236 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4736 | $17.0536 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.3391 | $13.2239 units |
|
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $0.3233 | $11.6436 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4076 | $15.9039 units |
|
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4119 | $16.0639 units |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4759 | $17.1336 units |
|
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3059 | $5.5118 units |
|
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.5099 | $18.3636 units |
|
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4052 | $15.8039 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3086 | $12.0439 units |
|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4989 | $17.9636 units |
|
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4784 | $17.2236 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | — | $0.3396 | $13.2439 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2243 | $4.0418 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4044 | $15.7739 units |
|
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4119 | $16.0639 units |
|
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4949 | $17.8236 units |
|
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.5318 | $19.1436 units |
|
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4003 | $15.6139 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.3130 | $12.2139 units |
|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4998 | $17.9936 units |
|
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4665 | $16.7936 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 42% | — | $0.3386 | $13.2139 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2113 | $3.8018 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.5224 | $18.8136 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4191 | $16.3439 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4259 | $16.6139 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4988 | $17.9636 units |
|
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4154 | $16.2039 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3084 | $12.0339 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $0.4779 | $17.2036 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5128 | $18.4636 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $0.3370 | $13.1439 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4065 | $15.8539 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4164 | $16.2439 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4797 | $17.2736 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.5194 | $18.7036 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3217 | $5.7918 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3107 | $12.1239 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4010 | $15.6439 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4948 | $17.8136 units |
|
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 26% | 26% | $0.4548 | $16.3736 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 39% | — | $0.3366 | $13.1339 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4291 | $16.7339 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4353 | $16.9839 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.5181 | $18.6536 units |
|
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.5007 | $18.0336 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4257 | $16.6039 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3141 | $5.6518 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.3105 | $12.1139 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $0.4765 | $17.1536 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5081 | $18.2936 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 37% | — | $0.3366 | $13.1339 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2097 | $3.7718 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4144 | $16.1639 units |
|
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4230 | $16.5039 units |
|
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.5020 | $18.0736 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4672 | $16.8236 units |
|
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4097 | $15.9839 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3112 | $12.1439 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4756 | $17.1236 units |
|
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4390 | $15.8036 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | — | $0.3365 | $13.1239 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4150 | $16.1839 units |
|
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4237 | $16.5239 units |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.5483 | $19.7436 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.5421 | $19.5236 units |
|
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3233 | $5.8218 units |
|
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4101 | $15.9939 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3136 | $12.2339 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5361 | $19.3036 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 29% | 29% | $0.4975 | $17.9136 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $0.3361 | $13.1139 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 — 10 plans, 10 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% | $0.5578 | $20.0836 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 23% | 18% | $0.4298 | $16.7639 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4354 | $16.9839 units |
|
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.5160 | $18.5836 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3198 | $5.7618 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.3118 | $12.1639 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4267 | $16.6439 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $0.4908 | $17.6736 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5265 | $18.9536 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.3397 | $13.2539 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4267 | $16.6439 units |
|
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $0.4319 | $16.8439 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.5121 | $18.4436 units |
|
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.5485 | $19.7536 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3257 | $5.8618 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.3191 | $12.4439 units |
|
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4237 | $16.5239 units |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.4869 | $17.5336 units |
|
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5196 | $18.7136 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | — | $0.3355 | $13.0839 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 — 10 plans, 10 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 | 24% | 24% | $0.5152 | $18.5536 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4134 | $16.1239 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4171 | $16.2739 units |
|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $0.4929 | $17.7436 units |
|
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3095 | $5.5718 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4113 | $16.0439 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $0.3053 | $11.9139 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4686 | $16.8736 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4984 | $17.9436 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.3385 | $13.2039 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 — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.2048 | $3.6918 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.3795 | $14.8039 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.3878 | $15.1239 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.4769 | $17.1736 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3750 | $14.6239 units |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $0.4845 | $17.4436 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.2980 | $11.6239 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4688 | $16.8836 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4348 | $15.6536 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | — | $0.3400 | $13.2639 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 — 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% | $0.5229 | $18.8236 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4205 | $16.4039 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4274 | $16.6739 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3391 | $6.1018 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $0.3104 | $12.1139 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4167 | $16.2539 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 27% | 27% | $0.4628 | $16.6636 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4992 | $17.9736 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.3380 | $13.1839 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 — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $0.4159 | $16.2239 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.4257 | $16.6039 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3266 | $5.8818 units |
|
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.4105 | $16.0139 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3179 | $12.4039 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $0.5602 | $20.1736 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 31% | 31% | $0.4754 | $17.1136 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.5181 | $18.6536 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | — | $0.3355 | $13.0839 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 — 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% | $0.5020 | $18.0736 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 24% | 19% | $0.3458 | $13.4939 units |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.3525 | $13.7539 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3450 | $6.2118 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $0.3160 | $12.3239 units |
|
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3421 | $13.3439 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $0.4555 | $16.4036 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4863 | $17.5136 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $0.3543 | $13.8239 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 — 8 plans, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3090 | $5.5618 units |
|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 3Preferred Brand | 23% | 18% | $0.3848 | $15.0139 units |
|
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $0.3856 | $15.0439 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $0.3844 | $14.9939 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $0.3169 | $12.3639 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 38% | — | $0.3354 | $13.0839 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $0.4400 | $15.8436 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 35% | 35% | $0.4112 | $14.8036 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% | $0.5816 | $20.9436 units |
|
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $0.5816 | $20.9436 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.3425 | $13.3639 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% | $0.3334 | $13.0039 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% | $0.3334 | $13.0039 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% | $0.3334 | $13.0039 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% | $0.3334 | $13.0039 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.