MARAVIROC 150 mg Tablet, Film Coated
Package: 60 TABLET, FILM COATED in 1 BOTTLE (31722-579-60). NDC 31722057960.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 5
- lower tiers cost less
- Plans with restrictions
- 258
- 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 | 5 | — | 9 of 12 plans |
| Pennsylvania and West Virginia | 12 of 12 | 5 | — | 7 of 12 plans |
| North Carolina | 12 of 12 | 5 | — | 9 of 12 plans |
| Alabama and Tennessee | 12 of 12 | 5 | — | 9 of 12 plans |
| Michigan | 12 of 12 | 5 | — | 7 of 12 plans |
| Illinois | 12 of 12 | 5 | — | 9 of 12 plans |
| Arkansas | 12 of 12 | 5 | — | 7 of 12 plans |
| Texas | 12 of 12 | 5 | — | 9 of 12 plans |
| Kansas | 12 of 12 | 5 | — | 9 of 12 plans |
| California | 12 of 12 | 5 | — | 9 of 12 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 5 | — | 6 of 11 plans |
| South Carolina | 11 of 11 | 5 | — | 8 of 11 plans |
| Oklahoma | 11 of 11 | 5 | — | 9 of 11 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 5 | — | 8 of 11 plans |
| New Mexico | 11 of 11 | 5 | — | 8 of 11 plans |
| New York | 10 of 10 | 5 | — | 7 of 10 plans |
| Delaware, DC and Maryland | 10 of 10 | 5 | — | 7 of 10 plans |
| Georgia | 10 of 10 | 5 | — | 7 of 10 plans |
| Florida | 10 of 10 | 5 | — | 7 of 10 plans |
| Ohio | 10 of 10 | 5 | — | 7 of 10 plans |
| Indiana and Kentucky | 10 of 10 | 5 | — | 7 of 10 plans |
| Wisconsin | 10 of 10 | 5 | — | 7 of 10 plans |
| Missouri | 10 of 10 | 5 | — | 7 of 10 plans |
| Mississippi | 10 of 10 | 5 | — | 7 of 10 plans |
| Louisiana | 10 of 10 | 5 | — | 7 of 10 plans |
| Colorado | 10 of 10 | 5 | — | 7 of 10 plans |
| Arizona | 10 of 10 | 5 | — | 7 of 10 plans |
| Nevada | 10 of 10 | 5 | — | 7 of 10 plans |
| Oregon and Washington | 10 of 10 | 5 | — | 7 of 10 plans |
| Idaho and Utah | 10 of 10 | 5 | — | 7 of 10 plans |
| Maine and New Hampshire | 9 of 9 | 5 | — | 6 of 9 plans |
| Virginia | 9 of 9 | 5 | — | 6 of 9 plans |
| Alaska | 9 of 9 | 5 | — | 6 of 9 plans |
| Hawaii | 8 of 8 | 5 | — | 5 of 8 plans |
| Puerto Rico | 3 of 3 | 5 | — | 3 of 3 plans |
| American Samoa | 1 of 1 | 5 | — | 1 of 1 plans |
| Guam | 1 of 1 | 5 | — | 1 of 1 plans |
| Northern Mariana Islands | 1 of 1 | 5 | — | 1 of 1 plans |
| U.S. Virgin Islands | 1 of 1 | 5 | — | 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, 9 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 | 5Specialty Tier | 25% | — | $23.9535 | $574.8824 units |
|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.9927 | — | None |
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.9927 | — | None |
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $23.9535 | $574.8824 units |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.8423 | $89.056 units |
|
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.1136 | $90.686 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.0530 | $102.326 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.6559 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.8000 | $88.806 units |
|
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $23.9535 | $574.8824 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.0720 | $102.436 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 5Specialty Tier | 30% | — | $15.1136 | $90.686 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, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.6824 | $544.3824 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.8262 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.8262 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $22.8270 | $547.8524 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.8995 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.7005 | $106.206 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.5170 | $87.106 units |
|
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.6441 | $87.866 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.7005 | $106.206 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $22.6011 | $542.4324 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 5Specialty Tier | 25% | — | $12.0808 | — | None |
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $12.0808 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
North Carolina — 12 plans, 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 | 5Specialty Tier | 25% | — | $16.9720 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.9720 | — | None |
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $26.1350 | $627.2424 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $26.1350 | $627.2424 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.5064 | $105.046 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.6917 | $100.156 units |
|
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.6502 | $99.906 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.1078 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.5327 | $99.206 units |
|
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $26.1350 | $627.2424 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.5064 | $105.046 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $16.6502 | $99.906 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, 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 | 5Specialty Tier | 25% | — | $28.5135 | $684.3224 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.1135 | — | None |
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.1135 | — | None |
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $28.5135 | $684.3224 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.5540 | $105.326 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $11.2885 | $67.736 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.1121 | $114.676 units |
|
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.2117 | $115.276 units |
|
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.3861 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $28.5135 | $684.3224 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.5540 | $105.326 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 5Specialty Tier | 31% | 31% | $11.2885 | $67.736 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, 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 | 5Specialty Tier | 25% | — | $15.2456 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.2456 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.9635 | $89.786 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $23.2838 | $558.8124 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $23.2838 | $558.8124 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.4143 | $98.496 units |
|
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.5100 | $87.066 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.7033 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.5067 | $99.046 units |
|
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.8462 | — | None |
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $23.2838 | $558.8124 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $14.8462 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Illinois — 12 plans, 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 | 5Specialty Tier | 25% | — | $22.7633 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.7633 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $28.3950 | $681.4824 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $28.3950 | $681.4824 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.7682 | $112.616 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.0101 | $132.066 units |
|
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.3059 | $109.846 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.6876 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $18.7682 | $112.616 units |
|
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.0521 | $132.316 units |
|
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $28.3950 | $681.4824 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.1381 | $102.836 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, 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 | 5Specialty Tier | 25% | — | $23.3800 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $23.3800 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.6400 | $135.846 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $34.7530 | $834.0724 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $34.7530 | $834.0724 units |
|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $11.7569 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.6400 | $135.846 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.9449 | $113.676 units |
|
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.0442 | — | None |
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $34.7530 | $834.0724 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $18.9449 | $113.676 units |
|
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $11.7569 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Texas — 12 plans, 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 | 5Specialty Tier | 25% | — | $16.9523 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.9523 | — | None |
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $25.7417 | $617.8024 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $25.7037 | $616.8924 units |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.1692 | $97.026 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.0701 | $102.426 units |
|
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.9739 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.3886 | $92.336 units |
|
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.2672 | $97.606 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.0701 | $102.426 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $25.6822 | $616.3724 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.0305 | $90.186 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, 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 | 5Specialty Tier | 25% | — | $18.8370 | $113.026 units |
|
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.2545 | $121.536 units |
|
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $23.4500 | $140.706 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.9400 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.9400 | — | None |
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.7584 | $522.2024 units |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $24.1760 | $580.2224 units |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $20.2545 | $121.536 units |
|
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.8453 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.8702 | $95.226 units |
|
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $20.3985 | $489.5624 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $15.8702 | $95.226 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, 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 | 5Specialty Tier | 25% | — | $16.3599 | $98.166 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.5235 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.5235 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.7608 | $100.566 units |
|
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.9727 | — | None |
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $24.9905 | $599.7724 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.4148 | $104.496 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $24.9703 | $599.2924 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.4148 | $104.496 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $24.9590 | $599.0224 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $33.0893 | $1,985.3660 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $33.0893 | $1,985.3660 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, 6 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $26.4745 | $635.3924 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.0070 | — | None |
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.2265 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.0070 | — | None |
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.6801 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.2775 | $109.666 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $26.6025 | $638.4624 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $26.4025 | $633.6624 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.8763 | $107.266 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $18.2775 | $109.666 units |
|
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $13.2265 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
South Carolina — 11 plans, 8 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 | 5Specialty Tier | 25% | — | $12.8177 | — | None |
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.8177 | — | None |
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.7338 | $521.6124 units |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $21.7338 | $521.6124 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.3634 | $74.186 units |
|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.3022 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.1159 | $96.706 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.1159 | $96.706 units |
|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.5234 | $123.146 units |
|
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.7338 | $521.6124 units |
|
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.7510 | $76.516 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, 9 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 | 5Specialty Tier | 25% | — | $12.2535 | $73.526 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.1540 | $507.7024 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.5051 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.5051 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $21.1540 | $507.7024 units |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $11.6711 | $70.036 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.8702 | $95.226 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.1540 | $507.7024 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $15.8702 | $95.226 units |
|
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.3874 | $74.326 units |
|
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.1015 | $84.616 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, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $24.9693 | $599.2624 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.4152 | $104.496 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.5893 | — | None |
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.5893 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $24.9693 | $599.2624 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.1536 | — | None |
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.4905 | $80.946 units |
|
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.7083 | $100.256 units |
|
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $24.9693 | $599.2624 units |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.7325 | $82.396 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.4152 | $104.496 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, 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 | 5Specialty Tier | 25% | — | $13.4503 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.4503 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.5768 | $81.466 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.9074 | $525.7824 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.1878 | $103.136 units |
|
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $21.9074 | $525.7824 units |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.9074 | $525.7824 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.1878 | $103.136 units |
|
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.5932 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.7330 | $100.406 units |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.8281 | $106.976 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, 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 | 5Specialty Tier | 25% | — | $14.2440 | $85.466 units |
|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.4913 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.4913 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.9980 | $83.996 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.5212 | $99.136 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.1924 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.9283 | $550.2824 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $22.9890 | $551.7424 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.5212 | $99.136 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $22.8942 | $549.4624 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, 7 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 | 5Specialty Tier | 25% | — | $22.6546 | $543.7124 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $22.6546 | $543.7124 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.9525 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.9525 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.7241 | $82.346 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.7931 | $100.766 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.7513 | $82.516 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.7931 | $100.766 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.0779 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $22.6546 | $543.7124 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, 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 | 5Specialty Tier | 25% | — | $14.7646 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.7646 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $23.7604 | $570.2524 units |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $23.7604 | $570.2524 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.3376 | $86.036 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.7571 | $100.546 units |
|
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.5081 | — | None |
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $23.7604 | $570.2524 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.7571 | $100.546 units |
|
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.5700 | $87.426 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, 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 | 5Specialty Tier | 25% | — | $15.4339 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.4339 | — | None |
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $24.1648 | $579.9624 units |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $24.1394 | $579.3524 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.3513 | — | None |
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.4267 | $98.566 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.9539 | $101.726 units |
|
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $24.1252 | $579.0024 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.9539 | $101.726 units |
|
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.4267 | $98.566 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, 7 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 | 5Specialty Tier | 25% | — | $23.2260 | $557.4224 units |
|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.6644 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.6644 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $23.2260 | $557.4224 units |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.8433 | $107.066 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.2738 | $103.646 units |
|
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.0260 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.0443 | $102.276 units |
|
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $23.2260 | $557.4224 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.2738 | $103.646 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, 7 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 | 5Specialty Tier | 25% | — | $25.9536 | $622.8924 units |
|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.6513 | — | None |
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.6513 | — | None |
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $25.9536 | $622.8924 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.1735 | — | None |
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.7792 | $94.686 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.1345 | $102.816 units |
|
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.2364 | $97.426 units |
|
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $25.9536 | $622.8924 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.1662 | $103.006 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, 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 | 5Specialty Tier | 25% | — | $13.5845 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.5845 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.1609 | $78.976 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $22.3903 | $537.3724 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $22.3903 | $537.3724 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.1497 | $96.906 units |
|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.6697 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.5636 | $75.386 units |
|
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $22.3903 | $537.3724 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.1497 | $96.906 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, 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 | 5Specialty Tier | 25% | — | $17.1896 | — | None |
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.1896 | — | None |
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $27.3869 | $657.2924 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $27.3869 | $657.2924 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.3169 | $97.906 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.1710 | $103.036 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.7381 | $100.436 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.2774 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.1710 | $103.036 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $27.3869 | $657.2924 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, 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 | 5Specialty Tier | 25% | — | $16.3507 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.3429 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.1540 | $507.7024 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $21.1540 | $507.7024 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.9676 | $77.816 units |
|
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $12.4272 | $74.566 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.8702 | $95.226 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.1540 | $507.7024 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.7151 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $15.8702 | $95.226 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, 7 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 | 5Specialty Tier | 25% | — | $23.5366 | $564.8824 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.2262 | — | None |
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.2262 | — | None |
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $23.5366 | $564.8824 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.4089 | $98.456 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.6100 | — | None |
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.0221 | $84.136 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.6002 | $81.606 units |
|
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $23.5366 | $564.8824 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.4089 | $98.456 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, 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 | 5Specialty Tier | 25% | — | $19.2318 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $27.1980 | $652.7524 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.2318 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $27.1980 | $652.7524 units |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.2938 | $115.766 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.3985 | $122.396 units |
|
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.5821 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.3604 | $110.166 units |
|
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $27.1980 | $652.7524 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $18.3604 | $110.166 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, 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 | 5Specialty Tier | 25% | — | $18.8296 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.8296 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.3062 | $115.846 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $25.1745 | $604.1924 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $25.1745 | $604.1924 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.7739 | $112.646 units |
|
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.9658 | $101.796 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.0987 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $18.7739 | $112.646 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $25.1745 | $604.1924 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, 7 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 | 5Specialty Tier | 25% | — | $22.5930 | $542.2324 units |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.6452 | — | None |
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.6452 | — | None |
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $22.5930 | $542.2324 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.5986 | $93.596 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.3520 | $98.116 units |
|
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.6190 | $93.716 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.7703 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $16.3520 | $98.116 units |
|
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $22.5930 | $542.2324 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, 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 | 5Specialty Tier | 25% | — | $18.2194 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.2194 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.7728 | $106.646 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $24.4065 | $585.7624 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $24.4065 | $585.7624 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.4232 | $104.546 units |
|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.6093 | $105.666 units |
|
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.0478 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $24.4065 | $585.7624 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.4925 | $104.956 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, 7 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 | 5Specialty Tier | 25% | — | $23.1320 | $555.1724 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.1105 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $23.1320 | $555.1724 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.1105 | — | None |
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.0788 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.8474 | $101.086 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.3174 | $97.906 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $23.1320 | $555.1724 units |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $17.0342 | $102.216 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.0232 | $102.146 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, 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 | 5Specialty Tier | 25% | — | $14.3200 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $14.3200 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $11.9400 | $71.646 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.1540 | $507.7024 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $21.1540 | $507.7024 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.8702 | $95.226 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.2152 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $15.8702 | $95.226 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.1540 | $507.7024 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, 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 | 5Specialty Tier | 25% | — | $21.2927 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.2927 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.4168 | $514.0024 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $21.4168 | $514.0024 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.2152 | $97.296 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $20.8439 | — | None |
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.4168 | $514.0024 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $17.4810 | $104.896 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.8764 | $131.266 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, 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 | 5Specialty Tier | 25% | — | $13.1169 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.0194 | $78.126 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $21.1540 | $507.7024 units |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $21.1540 | $507.7024 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $13.1169 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $15.8702 | $95.226 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $19.8714 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $15.8702 | $95.226 units |
|
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $21.1540 | $507.7024 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, 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 | 5Specialty Tier | 25% | — | $19.4389 | $116.636 units |
|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $25.8985 | $621.5624 units |
|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $16.2270 | — | None |
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.2638 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.2638 | — | None |
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $25.8985 | $621.5624 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $25.8985 | $621.5624 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $19.4389 | $116.636 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 | 5Specialty Tier | 25% | — | $18.4193 | $110.526 units |
|
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $18.7582 | $112.556 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $17.8864 | $107.326 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 | 5Specialty Tier | 25% | 25% | $17.2140 | $103.286 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 | 5Specialty Tier | 25% | 25% | $17.2140 | $103.286 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 | 5Specialty Tier | 25% | 25% | $17.2140 | $103.286 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 | 5Specialty Tier | 25% | 25% | $17.2140 | $103.286 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.