TRIUMEQ 600/50/300 mg Tablet, Film Coated
Also known as Abacavir Sulfate, Dolutegravir Sodium, Lamivudine. Package: 30 TABLET, FILM COATED in 1 BOTTLE (49702-231-13). NDC 49702023113.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 5
- lower tiers cost less
- Plans with restrictions
- 260
- 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 | — | 9 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% | — | $128.1617 | $384.493 units |
|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.0599 | — | None |
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.0599 | — | None |
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.1617 | $384.493 units |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.2948 | $384.883 units |
|
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.7125 | $404.143 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.5829 | $406.753 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.2719 | $384.823 units |
|
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.1617 | $384.493 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.5829 | $406.753 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 5Specialty Tier | 30% | — | $134.7125 | $404.143 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% | — | $127.5405 | $382.623 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $131.9376 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $131.9376 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.5405 | $382.623 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0696 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $133.7310 | $401.193 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.1809 | $378.543 units |
|
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.1725 | $378.523 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $133.7310 | $401.193 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.5405 | $382.623 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 5Specialty Tier | 25% | — | $126.6454 | — | None |
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $126.6048 | — | 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% | — | $142.3742 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $142.3742 | — | None |
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.4019 | $388.213 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.4019 | $388.213 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.0491 | $414.153 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.4950 | $388.493 units |
|
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.2200 | $408.663 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0817 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.4318 | $388.303 units |
|
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.4019 | $388.213 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $138.0491 | $414.153 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $136.2200 | $408.663 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% | — | $128.8485 | $386.553 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $141.5907 | — | None |
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $141.5907 | — | None |
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.8485 | $386.553 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $137.4516 | $412.353 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $137.4634 | $412.393 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.2613 | $387.783 units |
|
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.3363 | $388.013 units |
|
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0653 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.8485 | $386.553 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $137.4516 | $412.353 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 5Specialty Tier | 31% | 31% | $137.4634 | $412.393 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, 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% | — | $133.4721 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $133.4721 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.5523 | $382.663 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.0984 | $384.303 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.0984 | $384.303 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.6088 | $403.833 units |
|
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.5321 | $382.603 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $134.6088 | $403.833 units |
|
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.0949 | $3,842.8530 units |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.0984 | $384.303 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.0949 | $3,842.8530 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Illinois — 12 plans, 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% | — | $146.7388 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $146.7388 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.4768 | $391.433 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $130.4768 | $391.433 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $139.8512 | $419.553 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.5569 | $391.673 units |
|
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.1025 | $405.313 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $139.8512 | $419.553 units |
|
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.4616 | $391.383 units |
|
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $130.4768 | $391.433 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $133.7014 | $401.103 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.
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% | — | $138.3699 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.3699 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.7173 | $386.153 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.9405 | $386.823 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.9405 | $386.823 units |
|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.9041 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.7086 | $386.133 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $137.6122 | $412.843 units |
|
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.9405 | $386.823 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $137.6122 | $412.843 units |
|
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.9041 | — | 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% | — | $136.7948 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.7948 | — | None |
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.7541 | $386.263 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.7541 | $386.263 units |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.3460 | $385.043 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.2135 | $405.643 units |
|
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0777 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.0253 | $405.083 units |
|
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.3437 | $385.033 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.2135 | $405.643 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.7541 | $386.263 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.1400 | $402.423 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% | — | $136.7641 | $410.293 units |
|
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.6866 | $410.063 units |
|
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.7640 | $380.293 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.0437 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.0437 | — | None |
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.3289 | $384.993 units |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.3289 | $384.993 units |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $136.6866 | $410.063 units |
|
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.1289 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.1657 | $402.503 units |
|
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.3289 | $384.993 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $134.1657 | $402.503 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.
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% | — | $128.4617 | $385.393 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.9775 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.9775 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.5103 | $385.533 units |
|
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0709 | — | None |
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $130.2105 | $390.633 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.2021 | $408.613 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.2105 | $390.633 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.2021 | $408.613 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $130.2105 | $390.633 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.8336 | $3,895.0130 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.8336 | $3,895.0130 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% | — | $128.5907 | $385.773 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.9717 | — | None |
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.7688 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.9717 | — | None |
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0916 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.8301 | $407.493 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.5907 | $385.773 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.5907 | $385.773 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.5542 | $388.663 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.8301 | $407.493 units |
|
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.7688 | — | 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% | — | $126.7434 | — | None |
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.7434 | — | None |
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.2591 | $381.783 units |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.2591 | $381.783 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $123.9619 | $371.893 units |
|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0690 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.4391 | $403.323 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $134.4391 | $403.323 units |
|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.8879 | $386.663 units |
|
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.2591 | $381.783 units |
|
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $123.9893 | $371.973 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% | — | $133.9751 | $401.933 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.0892 | $381.273 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.6092 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.6092 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.0892 | $381.273 units |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.3769 | $379.133 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.6743 | $407.023 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.0892 | $381.273 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.6743 | $407.023 units |
|
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.3640 | $379.093 units |
|
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $133.4745 | $400.423 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% | — | $128.2370 | $384.713 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.7194 | $410.163 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.6338 | — | None |
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.6338 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.2370 | $384.713 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0716 | — | None |
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.3965 | $382.193 units |
|
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.7634 | $407.293 units |
|
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.2370 | $384.713 units |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.3778 | $382.133 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.7194 | $410.163 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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% | — | $129.2659 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.2659 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.4857 | $379.463 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.6957 | $380.093 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.0637 | $408.193 units |
|
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $126.6957 | $380.093 units |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $126.6957 | $380.093 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.0637 | $408.193 units |
|
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.1075 | $405.323 units |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.3677 | $409.103 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.
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% | — | $125.7890 | $377.373 units |
|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.5805 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.5805 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $125.8066 | $377.423 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.7332 | $404.203 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0724 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.9884 | $383.973 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.9884 | $383.973 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $134.7332 | $404.203 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.9884 | $383.973 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% | — | $127.4003 | $382.203 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.4003 | $382.203 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $132.2950 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $132.2950 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.3456 | $379.043 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.6049 | $403.813 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.3635 | $379.093 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $134.6049 | $403.813 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0849 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.4003 | $382.203 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% | — | $135.2071 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.2071 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.7970 | $389.393 units |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.7970 | $389.393 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.4693 | $382.413 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.7311 | $407.193 units |
|
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0765 | — | None |
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.7970 | $389.393 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.7311 | $407.193 units |
|
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.6384 | $382.923 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% | — | $134.9876 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.9876 | — | None |
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.9716 | $389.913 units |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.9716 | $389.913 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0717 | — | None |
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $137.5761 | $412.733 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.5628 | $406.693 units |
|
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.9716 | $389.913 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.5628 | $406.693 units |
|
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $137.5761 | $412.733 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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% | — | $129.0274 | $387.083 units |
|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.2998 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.2998 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.0274 | $387.083 units |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.2405 | $387.723 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.3327 | $406.003 units |
|
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0731 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.3190 | $387.963 units |
|
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.0274 | $387.083 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.3327 | $406.003 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% | — | $127.6243 | $382.873 units |
|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.0994 | — | None |
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $134.0994 | — | None |
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.6243 | $382.873 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0673 | — | None |
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.1439 | $381.433 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $133.4791 | $400.443 units |
|
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.1803 | $381.543 units |
|
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.6243 | $382.873 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $133.4791 | $400.443 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% | — | $133.1579 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $133.1579 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.0745 | $381.223 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.5419 | $382.633 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.5419 | $382.633 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.0665 | $408.203 units |
|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.1363 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.0667 | $381.203 units |
|
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.5419 | $382.633 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.0665 | $408.203 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% | — | $140.4661 | — | None |
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $140.4661 | — | None |
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.0357 | $387.113 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.0357 | $387.113 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.1131 | $387.343 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.0374 | $414.113 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.0568 | $387.173 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.4102 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $138.0374 | $414.113 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.0357 | $387.113 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% | — | $140.7817 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $140.7817 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.1026 | $384.313 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.1026 | $384.313 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.7500 | $389.253 units |
|
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.7359 | $389.213 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $132.9788 | $398.943 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.1026 | $384.313 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0817 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $132.9788 | $398.943 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% | — | $127.4801 | $382.443 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.8396 | — | None |
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.8396 | — | None |
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $127.4801 | $382.443 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.4299 | $406.293 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0660 | — | None |
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $125.1910 | $375.573 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $125.2088 | $375.633 units |
|
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $127.4801 | $382.443 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.4299 | $406.293 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.
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% | — | $137.5995 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.2870 | $384.863 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $137.5995 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.2870 | $384.863 units |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.0053 | $384.023 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.8017 | $383.413 units |
|
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0749 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $137.1879 | $411.563 units |
|
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.2870 | $384.863 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $137.1879 | $411.563 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.
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% | — | $144.5939 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $144.5939 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $132.8260 | $398.483 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.4761 | $388.433 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.4761 | $388.433 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $138.5498 | $415.653 units |
|
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $132.7648 | $398.293 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.1569 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $138.5498 | $415.653 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.4761 | $388.433 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% | — | $129.3158 | $387.953 units |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $139.4753 | — | None |
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $139.4753 | — | None |
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.3158 | $387.953 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.2618 | $390.793 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.1130 | $408.343 units |
|
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.2774 | $390.833 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.1130 | $408.343 units |
|
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.3158 | $387.953 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% | — | $132.0113 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $132.0113 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $127.9582 | $383.873 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.1879 | $387.563 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.1879 | $387.563 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $133.8483 | $401.543 units |
|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.2218 | $384.673 units |
|
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.2094 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.1879 | $387.563 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $133.8483 | $401.543 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.
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% | — | $128.1340 | $384.403 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.2660 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $128.1340 | $384.403 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.2660 | — | None |
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.7118 | $380.143 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.7183 | $410.153 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $128.1340 | $384.403 units |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.8382 | $380.513 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.7183 | $410.153 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% | — | $142.8520 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $142.8520 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.3571 | $391.073 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.4767 | $388.433 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.4767 | $388.433 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.1540 | $408.463 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.1540 | $408.463 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.4767 | $388.433 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% | — | $143.6552 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $143.6552 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $129.5897 | $388.773 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $129.5897 | $388.773 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $136.1753 | $408.533 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0837 | — | None |
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $129.5897 | $388.773 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $136.1753 | $408.533 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $131.5143 | $394.543 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.
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% | — | $141.2977 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $140.1536 | $420.463 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $126.1649 | $378.493 units |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $126.1649 | $378.493 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $141.2977 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $135.0145 | $405.043 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.0145 | $405.043 units |
|
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $126.1649 | $378.493 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.
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% | — | $135.2585 | $405.783 units |
|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.7564 | $392.273 units |
|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $130.0647 | — | None |
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $144.4881 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $144.4881 | — | None |
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $130.7564 | $392.273 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $130.7564 | $392.273 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $135.2585 | $405.783 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.
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% | — | $128.1299 | $384.393 units |
|
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $128.0615 | $384.183 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $135.5870 | $406.763 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.
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% | $139.7479 | $419.243 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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% | $136.1867 | $408.563 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 | 5Specialty Tier | 25% | 25% | $139.7479 | $419.243 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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% | $162.7935 | $488.383 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.