RISPERDAL CONSTA Kit
Also known as Risperidone. Package: 1 KIT in 1 BOX (50458-308-11) * 2 mL in 1 VIAL * 2 mL in 1 SYRINGE (50458-308-01). NDC 50458030811.
- Plans covering it
- 170
- across 39 regions checked
- Lowest tier
- 4
- lower tiers cost less
- Plans with restrictions
- 170
- prior auth, step therapy or quantity limit
Medicare Advantage plans in your county
Medicare Advantage drug plans in 48 states list this drug on their own formularies. Enter a ZIP code or choose a state to see every plan in a county, with its tier, cost-sharing and restrictions.
Coverage by region
Covered by at least one plan in 34 of 39 CMS regions; no plan covers it in 5.
| Region | Plans covering | Tiers | Lowest 30-day cost | Restrictions |
|---|---|---|---|---|
| Maine and New Hampshire | 5 of 9 | 4–5 | — | 5 of 5 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 5 of 11 | 4–5 | — | 5 of 5 plans |
| New York | 5 of 10 | 4–5 | — | 5 of 5 plans |
| New Jersey | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Delaware, DC and Maryland | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Pennsylvania and West Virginia | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Virginia | 5 of 9 | 4–5 | — | 5 of 5 plans |
| North Carolina | 5 of 12 | 4–5 | — | 5 of 5 plans |
| South Carolina | 5 of 11 | 4–5 | — | 5 of 5 plans |
| Georgia | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Florida | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Alabama and Tennessee | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Michigan | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Ohio | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Indiana and Kentucky | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Wisconsin | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Illinois | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Missouri | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Arkansas | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Mississippi | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Louisiana | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Texas | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Oklahoma | 5 of 11 | 4–5 | — | 5 of 5 plans |
| Kansas | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 5 of 11 | 4–5 | — | 5 of 5 plans |
| New Mexico | 5 of 11 | 4–5 | — | 5 of 5 plans |
| Colorado | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Arizona | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Nevada | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Oregon and Washington | 5 of 10 | 4–5 | — | 5 of 5 plans |
| Idaho and Utah | 5 of 10 | 4–5 | — | 5 of 5 plans |
| California | 5 of 12 | 4–5 | — | 5 of 5 plans |
| Hawaii | 5 of 8 | 4–5 | — | 5 of 5 plans |
| Alaska | 5 of 9 | 4–5 | — | 5 of 5 plans |
| American Samoa | no PDP | — | — | — |
| Guam | no PDP | — | — | — |
| Northern Mariana Islands | no PDP | — | — | — |
| Puerto Rico | no PDP | — | — | — |
| U.S. Virgin Islands | no PDP | — | — | — |
Plan-by-plan detail
Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.
Maine and New Hampshire — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1265.2879 | $2,530.582 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1308.4789 | $2,616.962 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1308.4789 | $2,616.962 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 4Non-Preferred Drug | 31% | — | $1265.2879 | $2,530.582 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1265.2879 | $2,530.582 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1258.8199 | $2,517.642 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1238.2474 | $2,476.492 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1238.2474 | $2,476.492 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 31% | — | $1258.8199 | $2,517.642 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1258.8199 | $2,517.642 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1220.4501 | $2,440.902 units |
|
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1220.4501 | $2,440.902 units |
|
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | — | $1253.2058 | $2,506.412 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 4Non-Preferred Drug | 31% | — | $1253.2058 | $2,506.412 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1253.2058 | $2,506.412 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 Jersey — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1258.8393 | $2,517.682 units |
|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1211.2044 | $2,422.412 units |
|
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1211.2044 | $2,422.412 units |
|
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 32% | — | $1258.8393 | $2,517.682 units |
|
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1258.8393 | $2,517.682 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1246.9035 | $2,493.812 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $1246.9035 | $2,493.812 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1191.0400 | $2,382.082 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1191.0400 | $2,382.082 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1246.9035 | $2,493.812 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1256.0757 | $2,512.152 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1233.3278 | $2,466.662 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1233.3278 | $2,466.662 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $1256.0757 | $2,512.152 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1256.0757 | $2,512.152 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1258.7733 | $2,517.552 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1258.7733 | $2,517.552 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1253.9382 | $2,507.882 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1253.9382 | $2,507.882 units |
|
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1258.7733 | $2,517.552 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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% | — | $1237.3409 | $2,474.682 units |
|
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1237.3409 | $2,474.682 units |
|
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1262.7042 | $2,525.412 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1262.7042 | $2,525.412 units |
|
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1262.7042 | $2,525.412 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
South Carolina — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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% | — | $1210.1777 | $2,420.362 units |
|
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1210.1777 | $2,420.362 units |
|
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 30% | — | $1253.3836 | $2,506.772 units |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1253.3836 | $2,506.772 units |
|
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1253.3836 | $2,506.772 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 34% | — | $1256.3292 | $2,512.662 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1293.3185 | $2,586.642 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1293.3185 | $2,586.642 units |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1256.3292 | $2,512.662 units |
|
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1256.3292 | $2,512.662 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1227.2322 | $2,454.462 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1227.2322 | $2,454.462 units |
|
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $1265.6337 | $2,531.272 units |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $1265.6337 | $2,531.272 units |
|
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1265.6337 | $2,531.272 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 34% | — | $1254.5654 | $2,509.132 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1208.8901 | $2,417.782 units |
|
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1208.8901 | $2,417.782 units |
|
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $1254.5654 | $2,509.132 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1254.5654 | $2,509.132 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1253.9808 | $2,507.962 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1253.9808 | $2,507.962 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1234.3119 | $2,468.622 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1234.3119 | $2,468.622 units |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1253.9808 | $2,507.962 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 31% | — | $1255.9116 | $2,511.822 units |
|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1261.3180 | $2,522.642 units |
|
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1261.3180 | $2,522.642 units |
|
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1255.9116 | $2,511.822 units |
|
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1255.9116 | $2,511.822 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1255.2755 | $2,510.552 units |
|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1259.8198 | $2,519.642 units |
|
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1259.8198 | $2,519.642 units |
|
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1255.2755 | $2,510.552 units |
|
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1255.2755 | $2,510.552 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1258.4581 | $2,516.922 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | — | $1258.4581 | $2,516.922 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1283.0282 | $2,566.062 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1283.0282 | $2,566.062 units |
|
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1258.4581 | $2,516.922 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 34% | — | $1262.5222 | $2,525.042 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | — | $1262.5222 | $2,525.042 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1245.5834 | $2,491.172 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1245.5834 | $2,491.172 units |
|
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1262.5222 | $2,525.042 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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% | — | $1221.5283 | $2,443.062 units |
|
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1221.5283 | $2,443.062 units |
|
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | — | $1260.9238 | $2,521.852 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1260.9238 | $2,521.852 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1260.9238 | $2,521.852 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 34% | — | $1256.1174 | $2,512.232 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1256.1174 | $2,512.232 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1196.7789 | $2,393.562 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1196.7789 | $2,393.562 units |
|
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1256.1174 | $2,512.232 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 35% | — | $1255.7384 | $2,511.482 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1236.5951 | $2,473.192 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1236.5951 | $2,473.192 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 35% | — | $1255.7384 | $2,511.482 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1255.7384 | $2,511.482 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1261.9031 | $2,523.812 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1201.8264 | $2,403.652 units |
|
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1201.8264 | $2,403.652 units |
|
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 4Non-Preferred Drug | 35% | — | $1261.9031 | $2,523.812 units |
|
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1261.9031 | $2,523.812 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Texas — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1234.3950 | $2,468.792 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1234.3950 | $2,468.792 units |
|
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1261.1186 | $2,522.242 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 4Non-Preferred Drug | 34% | — | $1261.1186 | $2,522.242 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1261.1186 | $2,522.242 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 29% | — | $1255.0153 | $2,510.032 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1242.4379 | $2,484.882 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1242.4379 | $2,484.882 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 35% | — | $1255.0153 | $2,510.032 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1255.0153 | $2,510.032 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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% | — | $1271.1403 | $2,542.282 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1271.1403 | $2,542.282 units |
|
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 35% | — | $1265.0162 | $2,530.032 units |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 32% | — | $1265.0162 | $2,530.032 units |
|
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1265.0162 | $2,530.032 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 34% | — | $1261.1137 | $2,522.232 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1248.0175 | $2,496.032 units |
|
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1248.0175 | $2,496.032 units |
|
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1261.1137 | $2,522.232 units |
|
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1261.1137 | $2,522.232 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1253.0842 | $2,506.172 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1306.7119 | $2,613.422 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1306.7119 | $2,613.422 units |
|
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 30% | — | $1253.0842 | $2,506.172 units |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1253.0842 | $2,506.172 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 31% | — | $1255.5273 | $2,511.052 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1251.8414 | $2,503.682 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1251.8414 | $2,503.682 units |
|
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1255.5273 | $2,511.052 units |
|
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1255.5273 | $2,511.052 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 30% | — | $1252.0584 | $2,504.122 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1331.8630 | $2,663.732 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1331.8630 | $2,663.732 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1252.0584 | $2,504.122 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1252.0584 | $2,504.122 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 32% | — | $1251.2753 | $2,502.552 units |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1336.3569 | $2,672.712 units |
|
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1336.3569 | $2,672.712 units |
|
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 4Non-Preferred Drug | 34% | — | $1251.2753 | $2,502.552 units |
|
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1251.2753 | $2,502.552 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1255.0180 | $2,510.042 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1300.3873 | $2,600.772 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1300.3873 | $2,600.772 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $1255.0180 | $2,510.042 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1255.0180 | $2,510.042 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 33% | — | $1253.3407 | $2,506.682 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1219.2872 | $2,438.572 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 4Non-Preferred Drug | 32% | — | $1253.3407 | $2,506.682 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1219.2872 | $2,438.572 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1253.3407 | $2,506.682 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1223.9551 | $2,447.912 units |
|
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1223.9551 | $2,447.912 units |
|
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 32% | — | $1255.5295 | $2,511.062 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | — | $1255.5295 | $2,511.062 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1255.5295 | $2,511.062 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible · $0 with full Extra Help | 4Non-Preferred Drug | 28% | — | $1261.1617 | $2,522.322 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1198.5265 | $2,397.052 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1198.5265 | $2,397.052 units |
|
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 30% | — | $1261.1617 | $2,522.322 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1261.1617 | $2,522.322 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 — 5 plans, 5 with restrictions
Showing 5 of 5 plans
| 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 · $0 with full Extra Help | 4Non-Preferred Drug | 28% | — | $1249.6266 | $2,499.252 units |
|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help | 5Specialty Tier | 25% | — | $1574.2200 | $3,148.442 units |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $1249.6266 | $2,499.252 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1574.2200 | $3,148.442 units |
|
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1249.6266 | $2,499.252 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.
No stand-alone Part D plan in American Samoa
None of the 1 stand-alone Part D plans in CMS PDP Region 35 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.
No stand-alone Part D plan in Guam
None of the 1 stand-alone Part D plans in CMS PDP Region 36 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.
No stand-alone Part D plan in Northern Mariana Islands
None of the 1 stand-alone Part D plans in CMS PDP Region 37 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.
No stand-alone Part D plan in Puerto Rico
None of the 3 stand-alone Part D plans in CMS PDP Region 38 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.
No stand-alone Part D plan in U.S. Virgin Islands
None of the 1 stand-alone Part D plans in CMS PDP Region 39 list this drug on their formulary. The patient would pay the full retail price, or you would need a formulary exception. It is on a Part D formulary elsewhere in the country.