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ESTRADIOL / NORETHINDRONE ACETATE 1/.5 mg Tablet, Film Coated

Also known as Estradiol And Norethindrone Acetate. Package: 1 BLISTER PACK in 1 CARTON (51991-474-28) / 28 TABLET, FILM COATED in 1 BLISTER PACK. NDC 51991047428.

Plans covering it
302
across 39 regions checked
Lowest tier
2
lower tiers cost less
Plans with restrictions
0
prior auth, step therapy or quantity limit

Medicare Advantage plans in your county

Medicare Advantage drug plans in 51 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 39 of 39 CMS regions.

RegionPlans coveringTiersLowest 30-day costRestrictions
Kansas11 of 122–4$0.00none
Connecticut, Massachusetts, Rhode Island and Vermont10 of 112–4$0.00none
New Jersey10 of 122–4$0.00none
Pennsylvania and West Virginia10 of 122–4$0.00none
North Carolina10 of 122–4$0.00none
Florida10 of 102–4$0.00none
Alabama and Tennessee10 of 122–4$0.00none
Illinois10 of 122–4$0.00none
Arkansas10 of 122–4$0.00none
Texas10 of 122–4$0.00none
New Mexico10 of 112–4$0.00none
Oklahoma9 of 112–4$0.00none
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming9 of 112–4$0.00none
Maine and New Hampshire8 of 92–4$0.00none
New York8 of 102–4$0.00none
Delaware, DC and Maryland8 of 102–4$0.00none
Virginia8 of 92–4$0.00none
South Carolina8 of 112–4$0.00none
Georgia8 of 102–4$0.00none
Michigan8 of 122–4$0.00none
Ohio8 of 102–4$0.00none
Indiana and Kentucky8 of 102–4$0.00none
Wisconsin8 of 102–4$0.00none
Missouri8 of 102–4$0.00none
Mississippi8 of 102–4$0.00none
Louisiana8 of 102–4$0.00none
Colorado8 of 102–4$0.00none
Arizona8 of 102–4$0.00none
Nevada8 of 102–4$0.00none
Oregon and Washington8 of 102–4$0.00none
Idaho and Utah8 of 102–4$0.00none
California8 of 122–4$0.00none
Hawaii8 of 82–4$0.00none
Alaska8 of 92–4$0.00none
American Samoa1 of 13—none
Guam1 of 13—none
Northern Mariana Islands1 of 13—none
Puerto Rico1 of 33—none
U.S. Virgin Islands1 of 13—none

Plan-by-plan detail

Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.

Kansas — 11 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug30%30%$1.5175—None
Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.6262—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$2.1837—None
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug26%26%$2.1598—None
Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0778—None
Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1078—None
Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible4Non-Preferred Drug40%40%$1.6262—None
SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.7200—None
AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible3Preferred Brand17%17%$1.0825—None
Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0607—None
AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible3Preferred Brand15%15%$1.0825—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.

Connecticut, Massachusetts, Rhode Island and Vermont — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1340—None
Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.9380—None
Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand17%17%$0.8690—None
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$1.9210—None
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$1.6967—None
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9763—None
Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1424—None
Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1292—None
AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible3Preferred Brand15%15%$0.9771—None
Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible3Preferred Brand$30.00$60.00$0.8690—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.

New Jersey — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1098—None
Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.8719—None
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$1.8423—None
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1234—None
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible4Non-Preferred Drug45%45%$0.9442—None
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible3Preferred Brand17%17%$1.0474—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.6151—None
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1021—None
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible3Preferred Brand15%15%$1.0474—None
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible4Non-Preferred Drug45%45%$0.9442—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.

Pennsylvania and West Virginia — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0679—None
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.9592—None
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$1.9421—None
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$1.0933—None
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$1.4360—None
AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible3Preferred Brand16%16%$0.9651—None
AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible3Preferred Brand16%16%$0.9651—None
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0534—None
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible2Generic$5.00$12.50$0.5821—None
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible2Generic25%25%$0.5821—None

Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.

North Carolina — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.8396—None
Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$1.8162—None
Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1165—None
Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1296—None
AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9586—None
Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$1.0396—None
SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.6130—None
Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1090—None
AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9586—None
Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible4Non-Preferred Drug40%40%$1.0396—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
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$1.9306—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.9601—None
Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1581—None
Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible3Preferred Brand25%20%$1.1481—None
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8496—None
BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.7934—None
AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9709—None
Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1425—None
AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9731—None
BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible4Non-Preferred Drug29%29%$0.7934—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.

Alabama and Tennessee — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1167—None
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.7284—None
Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$1.7017—None
Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1303—None
AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9744—None
BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible4Non-Preferred Drug41%41%$1.2189—None
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.5805—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1090—None
AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9744—None
BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible4Non-Preferred Drug42%42%$1.2189—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 — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$1.1368—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1311—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug31%31%$1.9801—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$2.0612—None
AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9865—None
Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible4Non-Preferred Drug43%43%$0.9414—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8005—None
AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9865—None
Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1279—None
Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$0.9535—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.

Arkansas — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$1.1122—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0823—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug26%26%$1.5936—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.6183—None
BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible3Preferred Brand19%19%$0.6617—None
AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9650—None
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.3925—None
Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0652—None
AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible3Preferred Brand16%16%$0.9650—None
BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible3Preferred Brand20%20%$0.6617—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 — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$1.9645—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.9939—None
Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1599—None
Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible3Preferred Brand25%20%$1.1474—None
AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9639—None
SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8225—None
Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible4Non-Preferred Drug42%42%$0.9803—None
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible3Preferred Brand18%18%$0.9639—None
Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1404—None
Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$1.0605—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.

New Mexico — 10 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1522—None
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand16%16%$0.9605—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug31%31%$2.0007—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$2.0378—None
Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1712—None
Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1413—None
AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible3Preferred Brand16%16%$0.9605—None
SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8722—None
Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.8941—None
Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.9031—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 — 9 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0815—None
Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.2005—None
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.6935—None
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug26%26%$1.6722—None
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1106—None
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9649—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0650—None
AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible3Preferred Brand16%16%$0.9649—None
Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible4Non-Preferred Drug32%32%$1.4461—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.

Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming — 9 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1019—None
AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand17%17%$1.0025—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.7442—None
Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$1.7138—None
Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1109—None
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$1.4510—None
MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible4Non-Preferred Drug42%42%$1.1942—None
Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0968—None
AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible3Preferred Brand18%18%$1.0025—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.

Maine and New Hampshire — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1564—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$1.9770—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$2.0118—None
Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1697—None
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9605—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.5604—None
AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible3Preferred Brand15%15%$0.9605—None
Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1487—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.

New York — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.7383—None
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$1.6953—None
AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9871—None
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.5246—None
Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible3Preferred Brand25%20%$1.1559—None
Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1634—None
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible3Preferred Brand15%15%$0.9871—None
Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1517—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.

Delaware, DC and Maryland — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1115—None
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1154—None
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.8778—None
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug31%31%$1.8512—None
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9929—None
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9982—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.4306—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1093—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.

Virginia — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$1.1404—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1204—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug31%31%$1.9885—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$2.0103—None
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9565—None
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.7776—None
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1090—None
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9565—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 — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.9427—None
Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$1.9283—None
Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0969—None
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1140—None
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.7715—None
AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9583—None
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9583—None
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0871—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.

Georgia — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0967—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$1.7793—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.7971—None
Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1066—None
AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9614—None
SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.6478—None
Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0911—None
AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible3Preferred Brand16%16%$0.9614—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.

Michigan — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$1.1637—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1533—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$1.8317—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.8740—None
AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9905—None
AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible3Preferred Brand18%18%$0.9961—None
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.6396—None
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1474—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.

Ohio — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0895—None
Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$2.1508—None
Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$2.1249—None
Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1090—None
AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9812—None
SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.7280—None
Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0784—None
AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9812—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.

Indiana and Kentucky — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0862—None
Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.6932—None
Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$1.6709—None
Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1014—None
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$1.4400—None
AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9981—None
Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0775—None
AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible3Preferred Brand18%18%$0.9981—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.

Wisconsin — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$1.2154—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1988—None
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand17%17%$0.9644—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug26%26%$1.3686—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.4214—None
SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible4Non-Preferred Drug35%35%$1.3568—None
Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1893—None
AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible3Preferred Brand15%15%$0.9644—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.

Missouri — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.8652—None
Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug26%26%$1.8160—None
Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1739—None
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1962—None
AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9642—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.6169—None
AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9642—None
Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1612—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.

Mississippi — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1401—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$1.5244—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$1.5588—None
Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1537—None
AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9632—None
Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1323—None
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.4645—None
AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible3Preferred Brand16%16%$0.9632—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.

Louisiana — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1705—None
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.6547—None
Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$1.6251—None
Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1850—None
AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible3Preferred Brand16%16%$0.9732—None
SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible4Non-Preferred Drug35%35%$1.5225—None
Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1622—None
AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible3Preferred Brand15%15%$0.9732—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.

Colorado — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.1491—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$2.2152—None
Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug29%29%$2.1750—None
Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1650—None
SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8892—None
AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible3Preferred Brand19%19%$0.9651—None
Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1400—None
AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9651—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.

Arizona — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand23%18%$1.1496—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug32%32%$2.0731—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$2.1042—None
Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1630—None
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.9710—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.9069—None
AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible3Preferred Brand18%18%$0.9710—None
Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1420—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.

Nevada — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0853—None
Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug31%31%$1.9442—None
Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.9576—None
Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible2Generic$0.00$0.00$1.0918—None
AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.9576—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8486—None
AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible3Preferred Brand18%18%$0.9576—None
Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0815—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.

Oregon and Washington — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0600—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$2.1034—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$2.1200—None
Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible2Generic$0.00$0.00$1.0708—None
AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9648—None
SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.7915—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0538—None
AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible3Preferred Brand16%16%$0.9648—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.

Idaho and Utah — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$1.0717—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.5481—None
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$1.0837—None
Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug27%27%$1.5258—None
SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$1.2086—None
AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9695—None
Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0649—None
AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9695—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.

California — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$1.9275—None
Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug31%31%$1.9131—None
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8266—None
Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1189—None
AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.9585—None
Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible3Preferred Brand25%20%$1.1144—None
AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible3Preferred Brand15%15%$0.9587—None
Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1119—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.

Hawaii — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand16%16%$0.9551—None
Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand23%18%$1.1421—None
SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$1.9242—None
Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$2.0242—None
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug35%35%$2.0046—None
Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.1451—None
Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible2Generic$4.00$0.00$1.1404—None
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible3Preferred Brand17%17%$0.9551—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 — 8 plans
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand24%19%$1.0445—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug28%28%$2.2087—None
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible2Generic$0.00$0.00$1.0543—None
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$2.2226—None
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible3Preferred Brand19%19%$0.9616—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$1.8155—None
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible3Preferred Brand18%18%$0.9616—None
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible2Generic$4.00$0.00$1.0389—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.

American Samoa — 1 plan
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$1.5436—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.

Guam — 1 plan
Prior authorization
Step therapy
Quantity limit
Extra Help (LIS)

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$1.5436—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.

Northern Mariana Islands — 1 plan
Prior authorization
Step therapy
Quantity limit

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$32.10/mo premium · $615.00 deductible3Preferred Brand25%25%$1.5436—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.

Puerto Rico — 1 plan
Prior authorization
Step therapy
Quantity limit

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8953—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.

U.S. Virgin Islands — 1 plan
Prior authorization
Step therapy
Quantity limit

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9830—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.