DOVATO 50/300 mg Tablet, Film Coated
Also known as Dolutegravir Sodium And Lamivudine. Package: 30 TABLET, FILM COATED in 1 BOTTLE (49702-246-13). NDC 49702024613.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 5
- lower tiers cost less
- Plans with restrictions
- 200
- 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 | — | 7 of 12 plans |
| Pennsylvania and West Virginia | 12 of 12 | 5 | — | 7 of 12 plans |
| North Carolina | 12 of 12 | 5 | — | 7 of 12 plans |
| Alabama and Tennessee | 12 of 12 | 5 | — | 7 of 12 plans |
| Michigan | 12 of 12 | 5 | — | 5 of 12 plans |
| Illinois | 12 of 12 | 5 | — | 7 of 12 plans |
| Arkansas | 12 of 12 | 5 | — | 5 of 12 plans |
| Texas | 12 of 12 | 5 | — | 7 of 12 plans |
| Kansas | 12 of 12 | 5 | — | 8 of 12 plans |
| California | 12 of 12 | 5 | — | 7 of 12 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 5 | — | 5 of 11 plans |
| South Carolina | 11 of 11 | 5 | — | 6 of 11 plans |
| Oklahoma | 11 of 11 | 5 | — | 7 of 11 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 5 | — | 6 of 11 plans |
| New Mexico | 11 of 11 | 5 | — | 7 of 11 plans |
| New York | 10 of 10 | 5 | — | 5 of 10 plans |
| Delaware, DC and Maryland | 10 of 10 | 5 | — | 5 of 10 plans |
| Georgia | 10 of 10 | 5 | — | 5 of 10 plans |
| Florida | 10 of 10 | 5 | — | 7 of 10 plans |
| Ohio | 10 of 10 | 5 | — | 5 of 10 plans |
| Indiana and Kentucky | 10 of 10 | 5 | — | 5 of 10 plans |
| Wisconsin | 10 of 10 | 5 | — | 5 of 10 plans |
| Missouri | 10 of 10 | 5 | — | 5 of 10 plans |
| Mississippi | 10 of 10 | 5 | — | 5 of 10 plans |
| Louisiana | 10 of 10 | 5 | — | 5 of 10 plans |
| Colorado | 10 of 10 | 5 | — | 5 of 10 plans |
| Arizona | 10 of 10 | 5 | — | 5 of 10 plans |
| Nevada | 10 of 10 | 5 | — | 5 of 10 plans |
| Oregon and Washington | 10 of 10 | 5 | — | 5 of 10 plans |
| Idaho and Utah | 10 of 10 | 5 | — | 5 of 10 plans |
| Maine and New Hampshire | 9 of 9 | 5 | — | 5 of 9 plans |
| Virginia | 9 of 9 | 5 | — | 5 of 9 plans |
| Alaska | 9 of 9 | 5 | — | 5 of 9 plans |
| Hawaii | 8 of 8 | 5 | — | 5 of 8 plans |
| Puerto Rico | 3 of 3 | 5 | — | 1 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, 7 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% | — | $103.5827 | $310.753 units |
|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.7123 | — | None |
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.7123 | — | None |
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.5827 | $310.753 units |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.4143 | — | None |
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $106.6952 | $320.093 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.4114 | $328.233 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.4040 | — | None |
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.5827 | $310.753 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.4114 | $328.233 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 5Specialty Tier | 30% | — | $106.6952 | $320.093 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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% | — | $103.1892 | $309.573 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.7445 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.7445 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.1892 | $309.573 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3175 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.8222 | $323.473 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $97.7259 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $97.7127 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $107.8222 | $323.473 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.1892 | $309.573 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 5Specialty Tier | 25% | — | $98.1823 | $2,945.4730 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $98.0646 | $2,941.9430 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
North Carolina — 12 plans, 7 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% | — | $110.7792 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.7792 | — | None |
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.5979 | $313.793 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.5979 | $313.793 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.8152 | $335.453 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.6873 | — | None |
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.6273 | $331.883 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3247 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.6450 | — | None |
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.5979 | $313.793 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $111.8152 | $335.453 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $110.6273 | $331.883 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, 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% | — | $104.3683 | $313.103 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.7169 | — | None |
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.7169 | — | None |
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.3683 | $313.103 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.9964 | $329.993 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $109.4191 | $328.263 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.4448 | — | None |
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.4653 | — | None |
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.3683 | $313.103 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.9964 | $329.993 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 5Specialty Tier | 31% | 31% | $109.4191 | $328.263 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.
Michigan — 12 plans, 5 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% | — | $105.9191 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.9191 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.1152 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.9763 | $311.933 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.9763 | $311.933 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.7626 | $329.293 units |
|
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.0918 | — | None |
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.7626 | $329.293 units |
|
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.6935 | — | None |
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.9763 | $311.933 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.6935 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Illinois — 12 plans, 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% | — | $114.6464 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $114.6464 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.8102 | $317.433 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $105.8102 | $317.433 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $113.3913 | $340.173 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.7888 | — | None |
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.1976 | $330.593 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $113.3913 | $340.173 units |
|
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.7303 | — | None |
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.8102 | $317.433 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $108.8822 | $326.653 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.
Arkansas — 12 plans, 5 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% | — | $105.1516 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.1516 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.1189 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.7929 | $311.383 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.7929 | $311.383 units |
|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.1851 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.9152 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.9193 | $329.763 units |
|
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.7929 | $311.383 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.9193 | $329.763 units |
|
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.1851 | — | 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, 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% | — | $104.8291 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.8291 | — | None |
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.0341 | $312.103 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.0341 | $312.103 units |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.4629 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.5683 | $328.703 units |
|
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3197 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.5122 | $322.543 units |
|
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.4617 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.5683 | $328.703 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.0341 | $312.103 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $106.6556 | $319.973 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.
Kansas — 12 plans, 8 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% | — | $109.1519 | $327.463 units |
|
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.1153 | $327.353 units |
|
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.4315 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.5765 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.5765 | — | None |
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.2030 | $312.613 units |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.2030 | $312.613 units |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $109.1153 | $327.353 units |
|
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3514 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $108.8792 | $326.643 units |
|
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.2030 | $312.613 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $108.8792 | $326.643 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
California — 12 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 | 5Specialty Tier | 25% | — | $99.7650 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $106.3818 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $106.3818 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.8107 | — | None |
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3195 | — | None |
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $105.4395 | $316.323 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.1154 | $330.353 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.4395 | $316.323 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $110.1154 | $330.353 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.4395 | $316.323 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.9310 | $3,147.9330 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.9310 | $3,147.9330 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, 5 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% | — | $103.8598 | $311.583 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.5882 | — | None |
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.4655 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.5882 | — | None |
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3337 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.8412 | $329.523 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.8598 | $311.583 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.8598 | $311.583 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.7695 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.8412 | $329.523 units |
|
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.4655 | — | 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, 6 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% | — | $98.4706 | — | None |
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.4706 | — | None |
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.0588 | $309.183 units |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.0588 | $309.183 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $96.4520 | — | None |
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $108.8558 | $326.573 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $108.8558 | $326.573 units |
|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.3538 | $313.063 units |
|
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.0588 | $309.183 units |
|
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $96.4537 | — | 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 — 11 plans, 7 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% | — | $105.8663 | $317.603 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.6197 | $310.863 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.9847 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.9847 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.6197 | $310.863 units |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.3806 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.6971 | $332.093 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.6197 | $310.863 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $110.6971 | $332.093 units |
|
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.3502 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.4010 | $316.203 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.
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming — 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)$4.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.1910 | $312.573 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.0465 | $333.143 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $106.2184 | — | None |
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $106.2184 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.1910 | $312.573 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3342 | — | None |
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.3138 | — | None |
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.0821 | $327.253 units |
|
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.1910 | $312.573 units |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.3290 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $111.0465 | $333.143 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.
New Mexico — 11 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% | — | $103.9710 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.9710 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.0984 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.4766 | $310.433 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.4416 | $331.323 units |
|
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.4766 | $310.433 units |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.4766 | $310.433 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $110.4416 | $331.323 units |
|
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.9746 | $323.923 units |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.1907 | $327.573 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.
New York — 10 plans, 5 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% | — | $98.3753 | — | None |
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.0197 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.0197 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.3929 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.2536 | $327.763 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3161 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.8314 | $311.493 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.8314 | $311.493 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.2536 | $327.763 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.8314 | $311.493 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.
Delaware, DC and Maryland — 10 plans, 5 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% | — | $103.6699 | $311.013 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.6699 | $311.013 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.4217 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.4217 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.6040 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $108.9684 | $326.913 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.6052 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $108.9684 | $326.913 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3200 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.6699 | $311.013 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, 5 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% | — | $102.7728 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.7728 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.8234 | $314.473 units |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.8234 | $314.473 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.2501 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.7340 | $329.203 units |
|
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3166 | — | None |
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.8234 | $314.473 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.7340 | $329.203 units |
|
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.3233 | — | 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.
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% | — | $104.6935 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.6935 | — | None |
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $105.1922 | $315.583 units |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.1922 | $315.583 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3166 | — | None |
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.8089 | $329.433 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.8138 | $329.443 units |
|
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.1922 | $315.583 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.8138 | $329.443 units |
|
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.8089 | $329.433 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.
Ohio — 10 plans, 5 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% | — | $105.0527 | $315.163 units |
|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.9480 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.9480 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $105.0527 | $315.163 units |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.6978 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.5289 | $328.593 units |
|
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3234 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.7561 | — | None |
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.0527 | $315.163 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.5289 | $328.593 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, 5 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% | — | $103.3849 | $310.153 units |
|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.4203 | — | None |
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.4203 | — | None |
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.3849 | $310.153 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.9840 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $108.5836 | $325.753 units |
|
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.0140 | — | None |
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.3849 | $310.153 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $108.5836 | $325.753 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Wisconsin — 10 plans, 5 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% | — | $100.3178 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.3178 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $97.6197 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.6717 | $308.023 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $102.6717 | $308.023 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.3718 | $328.123 units |
|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $97.6328 | — | None |
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $102.6717 | $308.023 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.3718 | $328.123 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, 5 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% | — | $108.6546 | — | None |
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $108.6546 | — | None |
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.3100 | $312.933 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.3100 | $312.933 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.0206 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.7715 | $335.313 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.9764 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3848 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $111.7715 | $335.313 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.3100 | $312.933 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Mississippi — 10 plans, 5 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% | — | $105.7379 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.7379 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.6779 | $311.033 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.6779 | $311.033 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.7446 | — | None |
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.7432 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $108.6175 | $325.853 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.6779 | $311.033 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3166 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $108.6175 | $325.853 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, 5 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% | — | $102.9200 | $308.763 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.2862 | — | None |
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $101.2862 | — | None |
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $102.9200 | $308.763 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.4159 | $328.253 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $97.6269 | — | None |
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $97.6275 | — | None |
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $102.9200 | $308.763 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.4159 | $328.253 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.
Colorado — 10 plans, 5 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% | — | $105.1081 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.7436 | $311.233 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.1081 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.7436 | $311.233 units |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.9712 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.8986 | — | None |
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.8240 | $332.473 units |
|
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.7436 | $311.233 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $110.8240 | $332.473 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.
Arizona — 10 plans, 5 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% | — | $113.4739 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $113.4739 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.2755 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.9995 | $315.003 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.9995 | $315.003 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $112.8633 | $338.593 units |
|
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $103.2945 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3162 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $112.8633 | $338.593 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.9995 | $315.003 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.
Nevada — 10 plans, 5 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% | — | $105.9575 | $317.873 units |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.4066 | — | None |
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.4066 | — | None |
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $105.9575 | $317.873 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.9147 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.5276 | $334.583 units |
|
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.9295 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $111.5276 | $334.583 units |
|
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.9575 | $317.873 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, 5 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% | — | $105.9630 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.9630 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.4823 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.9649 | $314.893 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.9649 | $314.893 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.3041 | $327.913 units |
|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.5106 | — | None |
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3247 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.9649 | $314.893 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.3041 | $327.913 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, 5 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% | — | $103.5353 | $310.613 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.7858 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $103.5353 | $310.613 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.7858 | — | None |
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3516 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.1665 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.2298 | $330.693 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $103.5353 | $310.613 units |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $98.3039 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $110.2298 | $330.693 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Maine and New Hampshire — 9 plans, 5 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% | — | $107.7130 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $107.7130 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $100.5403 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.2899 | $312.873 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $104.2899 | $312.873 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.8496 | $329.553 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $109.8496 | $329.553 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $104.2899 | $312.873 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, 5 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% | — | $112.8584 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $112.8584 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.0912 | $315.273 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $105.0912 | $315.273 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $110.9922 | $332.983 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3320 | — | None |
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.0912 | $315.273 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $110.9922 | $332.983 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.4250 | — | 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.
Alaska — 9 plans, 5 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% | — | $122.3274 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $121.4552 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $102.1604 | $306.483 units |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $102.1604 | $306.483 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $122.3274 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $104.4213 | $313.263 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3152 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $104.4213 | $313.263 units |
|
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $102.1604 | $306.483 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.
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% | — | $108.8908 | $326.673 units |
|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.7865 | $317.363 units |
|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $105.3448 | — | None |
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.7253 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $111.7253 | — | None |
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $105.7865 | $317.363 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $105.7865 | $317.363 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $108.8908 | $326.673 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
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 | 5Specialty Tier | 25% | — | $99.6710 | — | None |
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $99.6215 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $109.7170 | $329.153 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.
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% | $113.1558 | $339.473 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.
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% | $113.1558 | $339.473 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.
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% | $113.1558 | $339.473 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.
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% | $108.4033 | $325.213 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.