OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/25 mg Tablet
Package: 30 TABLET in 1 BOTTLE (43547-393-03). NDC 43547039303.
- Plans covering it
- 333
- across 39 regions checked
- Lowest tier
- 1
- lower tiers cost less
- Plans with restrictions
- 270
- 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 | 11 of 12 | 1–4 | $0.00 | 9 of 11 plans |
| Pennsylvania and West Virginia | 11 of 12 | 1–3 | $0.00 | 9 of 11 plans |
| North Carolina | 11 of 12 | 1–4 | $0.00 | 9 of 11 plans |
| Alabama and Tennessee | 11 of 12 | 1–4 | $0.00 | 9 of 11 plans |
| Michigan | 11 of 12 | 1–4 | $0.00 | 9 of 11 plans |
| Illinois | 11 of 12 | 1–4 | $0.00 | 9 of 11 plans |
| Arkansas | 11 of 12 | 1–4 | $0.00 | 9 of 11 plans |
| Texas | 11 of 12 | 1–4 | $0.00 | 9 of 11 plans |
| Kansas | 11 of 12 | 1–4 | $0.00 | 10 of 11 plans |
| California | 11 of 12 | 1–4 | $0.00 | 7 of 11 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 10 of 11 | 1–3 | $0.00 | 9 of 10 plans |
| South Carolina | 10 of 11 | 1–6 | $0.00 | 7 of 10 plans |
| Oklahoma | 10 of 11 | 1–3 | $0.00 | 8 of 10 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 10 of 11 | 1–3 | $0.00 | 8 of 10 plans |
| New Mexico | 10 of 11 | 1–4 | $0.00 | 9 of 10 plans |
| New York | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Delaware, DC and Maryland | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Georgia | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Florida | 9 of 10 | 1–6 | $0.00 | 9 of 9 plans |
| Ohio | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Indiana and Kentucky | 9 of 10 | 1–3 | $0.00 | 7 of 9 plans |
| Wisconsin | 9 of 10 | 1–3 | $0.00 | 7 of 9 plans |
| Missouri | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Mississippi | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Louisiana | 9 of 10 | 1–3 | $0.00 | 7 of 9 plans |
| Colorado | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Arizona | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Nevada | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Oregon and Washington | 9 of 10 | 1–4 | $0.00 | 7 of 9 plans |
| Idaho and Utah | 9 of 10 | 1–3 | $0.00 | 7 of 9 plans |
| Maine and New Hampshire | 8 of 9 | 1–4 | $0.00 | 7 of 8 plans |
| Virginia | 8 of 9 | 1–4 | $0.00 | 7 of 8 plans |
| Alaska | 8 of 9 | 1–4 | $0.00 | 7 of 8 plans |
| Hawaii | 7 of 8 | 1–3 | $0.00 | 7 of 7 plans |
| Puerto Rico | 3 of 3 | 1–2 | $0.00 | 1 of 3 plans |
| American Samoa | 1 of 1 | 2 | — | 1 of 1 plans |
| Guam | 1 of 1 | 2 | — | 1 of 1 plans |
| Northern Mariana Islands | 1 of 1 | 2 | — | 1 of 1 plans |
| U.S. Virgin Islands | 1 of 1 | 2 | — | 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 — 11 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1506 | $0.453 units |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2105 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3403 | — | None |
| Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6238 | $1.873 units |
|
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6283 | $1.883 units |
|
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6238 | $1.873 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5507 | $1.653 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 2Generic | $6.00 | $9.00 | $0.2845 | $0.853 units |
|
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.0124 | $3.043 units |
|
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.2845 | $0.853 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.4343 | $1.303 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 — 11 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1500 | $0.453 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0998 | $0.303 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2143 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3421 | — | None |
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2990 | $8.9730 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 1Preferred Generic | 25% | 25% | $0.2990 | $8.9730 units |
|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5959 | $1.793 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6072 | $1.823 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5678 | $1.703 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5959 | $1.793 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.0817 | $3.253 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 — 11 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1505 | $0.453 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2219 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3876 | — | None |
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6443 | $1.933 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6609 | $1.983 units |
|
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6443 | $1.933 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5146 | $1.543 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 2Generic | $6.00 | $18.00 | $0.3919 | $1.183 units |
|
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1959 | $3.593 units |
|
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.3919 | $1.183 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.4938 | $1.483 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 — 11 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1592 | $0.483 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2420 | — | None |
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3978 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6276 | $1.883 units |
|
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6443 | $1.933 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6276 | $1.883 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4938 | $1.483 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 2Generic | $12.00 | $24.00 | $0.3880 | $1.163 units |
|
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2125 | $3.643 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $0.3880 | $1.163 units |
|
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.4903 | $1.473 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Michigan — 11 plans, 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1429 | $0.433 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.3473 | — | None |
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2254 | — | None |
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 1Preferred Generic | $1.00 | $3.00 | $0.9008 | $2.703 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 1Preferred Generic | $1.00 | $2.00 | $0.9008 | $2.703 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5844 | $1.753 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5937 | $1.783 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5346 | $1.603 units |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5844 | $1.753 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1829 | $3.553 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5035 | $1.513 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 — 11 plans, 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.0913 | $0.273 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1656 | — | None |
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3756 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5915 | $1.773 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5979 | $1.793 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4495 | $1.353 units |
|
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5915 | $1.773 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 2Generic | $1.00 | $3.00 | $0.3115 | $0.933 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2987 | $3.903 units |
|
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $0.2871 | $0.863 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5155 | $1.553 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 — 11 plans, 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2763 | $0.833 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.4536 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3170 | — | None |
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $1.0161 | $3.053 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5423 | $1.633 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5689 | $1.713 units |
|
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5423 | $1.633 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $54.00 | $0.5169 | $1.553 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.0518 | $3.163 units |
|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $1.0161 | $3.053 units |
|
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.4295 | $1.293 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Texas — 11 plans, 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1385 | $0.423 units |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2132 | — | None |
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3722 | — | None |
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6393 | $1.923 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6220 | $1.873 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4842 | $1.453 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6220 | $1.873 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 2Generic | $1.00 | $3.00 | $0.4128 | $1.243 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2704 | $3.813 units |
|
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $0.3375 | $1.013 units |
|
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5361 | $1.613 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Kansas — 11 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.4083 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1834 | $0.553 units |
|
| Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $0.00 | $0.00 | $0.4565 | $1.373 units |
|
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5804 | $1.743 units |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6020 | $1.813 units |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 2Generic | $0.00 | $0.00 | $0.4780 | $1.433 units |
|
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5804 | $1.743 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5045 | $1.513 units |
|
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.4780 | $1.433 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2933 | $3.883 units |
|
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.6631 | $1.993 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 — 11 plans, 7 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 | 1Preferred Generic | 5% | 5% | $0.3233 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1440 | $0.433 units |
|
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2047 | — | None |
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6127 | $1.843 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6077 | $1.823 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5857 | $1.763 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6077 | $1.823 units |
|
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.9503 | $2.853 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $0.7440 | — | None |
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 3Preferred Brand | 19% | 19% | $0.7440 | — | None |
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.4372 | $1.313 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Connecticut, Massachusetts, Rhode Island and Vermont — 10 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0779 | $0.233 units |
|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0747 | $0.223 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3038 | — | None |
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 1Preferred Generic | $1.00 | $1.00 | $0.5172 | $1.553 units |
|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6821 | $2.053 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6875 | $2.063 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6821 | $2.053 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5729 | $1.723 units |
|
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $0.5172 | $1.553 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1510 | $3.453 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 — 10 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1532 | $0.463 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2302 | — | None |
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3720 | — | None |
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 2Generic | $2.00 | $0.00 | $0.6408 | $1.923 units |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6566 | $1.973 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5384 | $1.623 units |
|
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6408 | $1.923 units |
|
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1462 | $3.443 units |
|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.4936 | $1.483 units |
|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 6Select Care Drugs | $5.00 | $12.50 | $1.5921 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oklahoma — 10 plans, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2357 | $0.713 units |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2803 | — | None |
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.4482 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $2.00 | $0.00 | $0.6108 | $1.833 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6376 | $1.913 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6108 | $1.833 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5030 | $1.513 units |
|
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 2Generic | $1.00 | $3.00 | $0.5328 | $1.603 units |
|
| Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $0.4021 | $1.213 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1662 | $3.503 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 — 10 plans, 8 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2079 | $0.623 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2386 | $0.723 units |
|
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2517 | — | None |
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3637 | — | None |
| Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5428 | $1.633 units |
|
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5553 | $1.673 units |
|
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5428 | $1.633 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5132 | $1.543 units |
|
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1730 | $3.523 units |
|
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $0.4302 | $1.293 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
New Mexico — 10 plans, 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1507 | $0.453 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.4433 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6442 | $1.933 units |
|
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6653 | $2.003 units |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6442 | $1.933 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4135 | $1.243 units |
|
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 2Generic | $4.00 | $12.00 | $0.3991 | $1.203 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.3575 | $4.073 units |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $0.3452 | $1.043 units |
|
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5584 | $1.683 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 — 9 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 | 1Preferred Generic | 5% | 5% | $0.3244 | — | None |
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1810 | $0.543 units |
|
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2293 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5811 | $1.743 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5834 | $1.753 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5955 | $1.793 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5811 | $1.743 units |
|
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $0.8166 | $2.453 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.3651 | $1.103 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 — 9 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0892 | $0.273 units |
|
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3294 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1856 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6414 | $1.923 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6484 | $1.953 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5317 | $1.603 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6414 | $1.923 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2057 | $3.623 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5084 | $1.533 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 — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1420 | $0.433 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2400 | — | None |
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3728 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6199 | $1.863 units |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6344 | $1.903 units |
|
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6199 | $1.863 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5154 | $1.553 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2059 | $3.623 units |
|
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5149 | $1.543 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 — 9 plans, 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1030 | $0.313 units |
|
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6874 | $2.063 units |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6785 | $2.043 units |
|
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6785 | $2.043 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4956 | $1.493 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2497 | $3.753 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5256 | $1.583 units |
|
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 6Select Care Drugs | $3.00 | $9.00 | $0.2787 | $0.843 units |
|
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 6Select Care Drugs | $0.00 | $0.00 | $0.2787 | $0.843 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 — 9 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1374 | $0.413 units |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2142 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3696 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5900 | $1.773 units |
|
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6046 | $1.813 units |
|
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5900 | $1.773 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.6129 | $1.843 units |
|
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.3006 | $3.903 units |
|
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5335 | $1.603 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 — 9 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1563 | $0.473 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0901 | $0.273 units |
|
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2248 | — | None |
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3732 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6034 | $1.813 units |
|
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6190 | $1.863 units |
|
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6034 | $1.813 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5251 | $1.583 units |
|
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1645 | $3.493 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 — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1366 | $0.413 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.3982 | — | None |
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1043 | $0.313 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2155 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6518 | $1.963 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6649 | $1.993 units |
|
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6518 | $1.963 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4453 | $1.343 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2635 | $3.793 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 — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1901 | $0.573 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2459 | — | None |
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.4057 | — | None |
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6303 | $1.893 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6536 | $1.963 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5068 | $1.523 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6303 | $1.893 units |
|
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2154 | $3.653 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5134 | $1.543 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 — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2375 | $0.713 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.4210 | — | None |
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2837 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5691 | $1.713 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5898 | $1.773 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5691 | $1.713 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5236 | $1.573 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.0161 | $3.053 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.4522 | $1.363 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Louisiana — 9 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2154 | $0.653 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1023 | $0.313 units |
|
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.4186 | — | None |
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2641 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6206 | $1.863 units |
|
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6434 | $1.933 units |
|
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6206 | $1.863 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5131 | $1.543 units |
|
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.0879 | $3.263 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 — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1215 | $0.363 units |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.4033 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2191 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5579 | $1.673 units |
|
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5726 | $1.723 units |
|
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5579 | $1.673 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4432 | $1.333 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.3416 | $4.023 units |
|
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5443 | $1.633 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Arizona — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.0987 | $0.303 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.3905 | — | None |
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1805 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $0.00 | $0.6647 | $1.993 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6789 | $2.043 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.6021 | $1.813 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6647 | $1.993 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.3677 | $4.103 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5862 | $1.763 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 — 9 plans, 7 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0922 | $0.283 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1789 | — | None |
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3731 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6714 | $2.013 units |
|
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6842 | $2.053 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4687 | $1.413 units |
|
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6714 | $2.013 units |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.3223 | $3.973 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5515 | $1.653 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oregon and Washington — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1227 | $0.373 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.3820 | — | None |
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2115 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5547 | $1.663 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5641 | $1.693 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5547 | $1.663 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4686 | $1.413 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2438 | $3.733 units |
|
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5010 | $1.503 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 — 9 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1725 | $0.523 units |
|
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1037 | $0.313 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2604 | — | None |
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.4077 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.5382 | $1.613 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.5535 | $1.663 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.5382 | $1.613 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4770 | $1.433 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.1875 | $3.563 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Maine and New Hampshire — 8 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1481 | $0.443 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | 5% | 5% | $0.3923 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6222 | $1.873 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6396 | $1.923 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4815 | $1.443 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6222 | $1.873 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2843 | $3.853 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5210 | $1.563 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Virginia — 8 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1258 | $0.383 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3678 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $0.00 | $0.6443 | $1.933 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6604 | $1.983 units |
|
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6443 | $1.933 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.5150 | $1.543 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.2381 | $3.713 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.5247 | $1.573 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 — 8 plans, 7 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 | 1Preferred Generic | 5% | 5% | $0.4992 | — | None |
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2059 | $0.623 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $0.00 | $0.4818 | $1.453 units |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.4895 | $1.473 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.4369 | $1.313 units |
|
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.4818 | $1.453 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.4480 | $4.343 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.6907 | $2.073 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 — 7 plans, 7 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 | 1Preferred Generic | $2.00 | $6.00 | $0.1250 | $0.383 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0701 | $0.213 units |
|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 2Generic | $4.00 | $0.00 | $0.6881 | $2.063 units |
|
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 2Generic | $0.00 | $0.00 | $0.6918 | $2.083 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 2Generic | $4.00 | $0.00 | $0.6881 | $2.063 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $0.6258 | $1.883 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $1.0419 | $3.133 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, 1 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2354 | — | None |
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3884 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $0.5614 | $1.683 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 | 2Generic | 25% | 25% | $0.8538 | $2.563 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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 | 2Generic | 25% | 25% | $0.8538 | $2.563 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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 | 2Generic | 25% | 25% | $0.8538 | $2.563 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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 | 2Generic | 25% | 25% | $0.5928 | $1.783 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.