INQOVI 100/35 mg Tablet, Film Coated
Also known as Cedazuridine And Decitabine. Package: 1 BLISTER PACK in 1 CARTON (64842-0727-9) / 5 TABLET, FILM COATED in 1 BLISTER PACK. NDC 64842072709.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 5
- lower tiers cost less
- Plans with restrictions
- 367
- prior auth, step therapy or quantity limit
Coverage by region
Covered by at least one plan in 39 of 39 CMS regions.
| Region | Plans covering | Tiers | Lowest 30-day cost | Restrictions |
|---|---|---|---|---|
| New Jersey | 12 of 12 | 5 | — | 12 of 12 plans |
| Pennsylvania and West Virginia | 12 of 12 | 5 | — | 12 of 12 plans |
| North Carolina | 12 of 12 | 5 | — | 12 of 12 plans |
| Alabama and Tennessee | 12 of 12 | 5 | — | 12 of 12 plans |
| Michigan | 12 of 12 | 5 | — | 12 of 12 plans |
| Illinois | 12 of 12 | 5 | — | 12 of 12 plans |
| Arkansas | 12 of 12 | 5 | — | 12 of 12 plans |
| Texas | 12 of 12 | 5 | — | 12 of 12 plans |
| Kansas | 12 of 12 | 5 | — | 12 of 12 plans |
| California | 12 of 12 | 5 | — | 12 of 12 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 5 | — | 11 of 11 plans |
| South Carolina | 11 of 11 | 5 | — | 11 of 11 plans |
| Oklahoma | 11 of 11 | 5 | — | 11 of 11 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 5 | — | 11 of 11 plans |
| New Mexico | 11 of 11 | 5 | — | 11 of 11 plans |
| New York | 10 of 10 | 5 | — | 10 of 10 plans |
| Delaware, DC and Maryland | 10 of 10 | 5 | — | 10 of 10 plans |
| Georgia | 10 of 10 | 5 | — | 10 of 10 plans |
| Florida | 10 of 10 | 5 | — | 10 of 10 plans |
| Ohio | 10 of 10 | 5 | — | 10 of 10 plans |
| Indiana and Kentucky | 10 of 10 | 5 | — | 10 of 10 plans |
| Wisconsin | 10 of 10 | 5 | — | 10 of 10 plans |
| Missouri | 10 of 10 | 5 | — | 10 of 10 plans |
| Mississippi | 10 of 10 | 5 | — | 10 of 10 plans |
| Louisiana | 10 of 10 | 5 | — | 10 of 10 plans |
| Colorado | 10 of 10 | 5 | — | 10 of 10 plans |
| Arizona | 10 of 10 | 5 | — | 10 of 10 plans |
| Nevada | 10 of 10 | 5 | — | 10 of 10 plans |
| Oregon and Washington | 10 of 10 | 5 | — | 10 of 10 plans |
| Idaho and Utah | 10 of 10 | 5 | — | 10 of 10 plans |
| Maine and New Hampshire | 9 of 9 | 5 | — | 9 of 9 plans |
| Virginia | 9 of 9 | 5 | — | 9 of 9 plans |
| Alaska | 9 of 9 | 5 | — | 9 of 9 plans |
| Hawaii | 8 of 8 | 5 | — | 8 of 8 plans |
| Puerto Rico | 3 of 3 | 5 | — | 3 of 3 plans |
| American Samoa | 1 of 1 | 5 | — | 1 of 1 plans |
| Guam | 1 of 1 | 5 | — | 1 of 1 plans |
| Northern Mariana Islands | 1 of 1 | 5 | — | 1 of 1 plans |
| U.S. Virgin Islands | 1 of 1 | 5 | — | 1 of 1 plans |
Plan-by-plan detail
Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.
New Jersey — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1691.7091 | $8,458.555 units |
|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1701.9822 | $8,509.915 units |
|
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1701.9822 | $8,509.915 units |
|
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1691.7091 | $8,458.555 units |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1701.8390 | $8,509.195 units |
|
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1695.3276 | $8,476.645 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1701.8390 | $8,509.195 units |
|
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1691.7091 | $8,458.555 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 5Specialty Tier | 30% | — | $1695.3276 | $8,476.645 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Pennsylvania and West Virginia — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1699.6129 | $8,498.065 units |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1605.1760 | $8,025.885 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1605.1760 | $8,025.885 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1699.6129 | $8,498.065 units |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1800.8367 | $9,004.185 units |
|
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1604.8720 | $8,024.365 units |
|
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1604.8720 | $8,024.365 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1800.8367 | $9,004.185 units |
|
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1699.6129 | $8,498.065 units |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 5Specialty Tier | 25% | — | $1604.8720 | $8,024.365 units |
|
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $1605.1760 | $8,025.885 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
North Carolina — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1627.4618 | $8,137.315 units |
|
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1627.4618 | $8,137.315 units |
|
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1735.4094 | $8,677.055 units |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1735.4094 | $8,677.055 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1789.5649 | $8,947.825 units |
|
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1626.6551 | $8,133.285 units |
|
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1748.6373 | $8,743.195 units |
|
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1626.6551 | $8,133.285 units |
|
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1735.4094 | $8,677.055 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1789.5649 | $8,947.825 units |
|
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1748.6373 | $8,743.195 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Alabama and Tennessee — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1701.8598 | $8,509.305 units |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1617.8772 | $8,089.395 units |
|
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1617.8772 | $8,089.395 units |
|
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1701.8598 | $8,509.305 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1797.5114 | $8,987.565 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $1645.8467 | $8,229.235 units |
|
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1617.5533 | $8,087.775 units |
|
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1617.5533 | $8,087.775 units |
|
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1701.8598 | $8,509.305 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1797.5114 | $8,987.565 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 5Specialty Tier | 31% | 31% | $1645.8467 | $8,229.235 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Michigan — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1589.7922 | $7,948.965 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1589.7922 | $7,948.965 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1592.7590 | $7,963.805 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1700.8202 | $8,504.105 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1700.8202 | $8,504.105 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1793.5084 | $8,967.545 units |
|
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1593.3616 | $7,966.815 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1793.5084 | $8,967.545 units |
|
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1733.6544 | — |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1700.8202 | $8,504.105 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1733.6544 | — |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Illinois — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1598.4175 | $7,992.095 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1598.4175 | $7,992.095 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1598.0575 | $7,990.295 units |
|
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1628.7823 | $8,143.915 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1598.0575 | $7,990.295 units |
|
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1628.6672 | $8,143.345 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Arkansas — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1618.8557 | $8,094.285 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1618.8557 | $8,094.285 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1618.3876 | $8,091.945 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1747.4724 | $8,737.365 units |
|
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1618.3876 | $8,091.945 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1737.4456 | $8,687.235 units |
|
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1805.6926 | $9,028.465 units |
|
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1737.4456 | $8,687.235 units |
|
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1747.4724 | $8,737.365 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 — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1603.6794 | $8,018.405 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1603.6794 | $8,018.405 units |
|
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1705.9487 | $8,529.745 units |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1705.9487 | $8,529.745 units |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1603.6417 | $8,018.215 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1793.9853 | $8,969.935 units |
|
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1680.7076 | $8,403.545 units |
|
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1603.6417 | $8,018.215 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1793.9853 | $8,969.935 units |
|
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1705.9487 | $8,529.745 units |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1680.7191 | $8,403.605 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Kansas — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1617.1967 | $8,085.985 units |
|
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1617.1967 | $8,085.985 units |
|
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1523.0267 | $7,615.135 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1523.0267 | $7,615.135 units |
|
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1523.0267 | $7,615.135 units |
|
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1617.1967 | $8,085.985 units |
|
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1702.8317 | $8,514.165 units |
|
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1702.8317 | $8,514.165 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
California — 12 plans, 12 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1595.3143 | $7,976.575 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1591.4536 | $7,957.275 units |
|
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1591.4536 | $7,957.275 units |
|
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1595.3143 | $7,976.575 units |
|
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1703.8390 | $8,519.195 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1797.5434 | $8,987.725 units |
|
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1703.8390 | $8,519.195 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1797.5434 | $8,987.725 units |
|
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1703.8390 | $8,519.195 units |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1746.7237 | $8,733.625 units |
|
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1746.7237 | $8,733.625 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Connecticut, Massachusetts, Rhode Island and Vermont — 11 plans, 11 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1701.3467 | $8,506.735 units |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1592.1356 | $7,960.685 units |
|
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1720.2737 | $8,601.375 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1592.1356 | $7,960.685 units |
|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1701.3467 | $8,506.735 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1701.3467 | $8,506.735 units |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1592.1290 | $7,960.645 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1720.2737 | $8,601.375 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 — 11 plans, 11 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1606.9145 | $8,034.575 units |
|
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1606.9145 | $8,034.575 units |
|
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1699.2702 | $8,496.355 units |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1699.2702 | $8,496.355 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1606.9145 | $8,034.575 units |
|
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1785.2733 | — |
|
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1699.2702 | $8,496.355 units |
|
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1606.9145 | $8,034.575 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oklahoma — 11 plans, 11 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1654.7775 | $8,273.895 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1693.9606 | $8,469.805 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1624.1779 | $8,120.895 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1624.1779 | $8,120.895 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1693.9606 | $8,469.805 units |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1621.6502 | $8,108.255 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1798.7735 | $8,993.875 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1693.9606 | $8,469.805 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1798.7735 | $8,993.875 units |
|
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1621.6502 | $8,108.255 units |
|
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1655.2610 | $8,276.315 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming — 11 plans, 11 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1698.8535 | $8,494.275 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1791.9736 | $8,959.875 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1627.4974 | $8,137.495 units |
|
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1627.4974 | $8,137.495 units |
|
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1698.8535 | $8,494.275 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1627.2636 | $8,136.325 units |
|
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1709.9791 | $8,549.905 units |
|
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1698.8535 | $8,494.275 units |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1627.2636 | $8,136.325 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1791.9736 | $8,959.875 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
New Mexico — 11 plans, 11 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1590.4530 | $7,952.265 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1590.4530 | $7,952.265 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1590.4530 | $7,952.265 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1652.5063 | $8,262.535 units |
|
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1652.5063 | $8,262.535 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
New York — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1655.9651 | $8,279.835 units |
|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1658.5216 | $8,292.615 units |
|
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1658.5216 | $8,292.615 units |
|
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1655.9651 | $8,279.835 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1724.6021 | $8,623.015 units |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1724.6021 | $8,623.015 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1724.6021 | $8,623.015 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Delaware, DC and Maryland — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1676.7397 | $8,383.705 units |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1676.7397 | $8,383.705 units |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1562.8568 | $7,814.285 units |
|
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1562.8568 | $7,814.285 units |
|
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1562.8568 | $7,814.285 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1796.7904 | $8,983.955 units |
|
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1562.8568 | $7,814.285 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1796.7904 | $8,983.955 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1676.7397 | $8,383.705 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Georgia — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1597.4755 | $7,987.385 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1597.4755 | $7,987.385 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.9298 | $8,464.655 units |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.9298 | $8,464.655 units |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1597.3350 | $7,986.685 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1797.9776 | $8,989.895 units |
|
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.9298 | $8,464.655 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1797.9776 | $8,989.895 units |
|
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1597.3350 | $7,986.685 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Florida — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1600.3303 | $8,001.655 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1600.3303 | $8,001.655 units |
|
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1724.4233 | $8,622.125 units |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1724.4233 | $8,622.125 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1706.6421 | $8,533.215 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1800.2013 | $9,001.015 units |
|
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1724.4233 | $8,622.125 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1800.2013 | $9,001.015 units |
|
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1706.6421 | $8,533.215 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Ohio — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1702.8959 | $8,514.485 units |
|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1629.0579 | $8,145.295 units |
|
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1629.0579 | $8,145.295 units |
|
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1702.8959 | $8,514.485 units |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1628.2635 | $8,141.325 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1628.2635 | $8,141.325 units |
|
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1702.8959 | $8,514.485 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Indiana and Kentucky — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1727.5202 | $8,637.605 units |
|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1593.5759 | $7,967.885 units |
|
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1593.5759 | $7,967.885 units |
|
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1727.5202 | $8,637.605 units |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.3220 | $9,071.615 units |
|
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1593.5759 | $7,967.885 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1800.3935 | $9,001.975 units |
|
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1593.5759 | $7,967.885 units |
|
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1727.5202 | $8,637.605 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1800.3935 | $9,001.975 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Wisconsin — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1590.4629 | $7,952.315 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1590.4629 | $7,952.315 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1589.5884 | $7,947.945 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1589.5884 | $7,947.945 units |
|
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Missouri — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1597.1088 | $7,985.545 units |
|
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1597.1088 | $7,985.545 units |
|
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1694.7490 | $8,473.755 units |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1694.7490 | $8,473.755 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.2205 | $7,971.105 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.2205 | $7,971.105 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1694.7490 | $8,473.755 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Mississippi — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1718.7322 | $8,593.665 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1718.7322 | $8,593.665 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1715.5533 | $8,577.775 units |
|
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1715.3216 | $8,576.615 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1690.2315 | $8,451.165 units |
|
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1690.2315 | $8,451.165 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Louisiana — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.2652 | $7,971.335 units |
|
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.2652 | $7,971.335 units |
|
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.2652 | $7,971.335 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.2652 | $7,971.335 units |
|
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Colorado — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1596.6992 | $7,983.505 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1698.2390 | $8,491.195 units |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1596.6992 | $7,983.505 units |
|
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1698.2390 | $8,491.195 units |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1596.6992 | $7,983.505 units |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1596.6992 | $7,983.505 units |
|
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1698.2390 | $8,491.195 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Arizona — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1639.7269 | $8,198.635 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1639.7269 | $8,198.635 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1638.6160 | $8,193.085 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1724.8570 | $8,624.285 units |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1724.8570 | $8,624.285 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1638.6160 | $8,193.085 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1724.8570 | $8,624.285 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Nevada — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1806.3716 | $9,031.865 units |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1591.9600 | $7,959.805 units |
|
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1591.9600 | $7,959.805 units |
|
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1806.3716 | $9,031.865 units |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1591.9600 | $7,959.805 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1591.9600 | $7,959.805 units |
|
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1806.3716 | $9,031.865 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oregon and Washington — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1636.3303 | $8,181.655 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1636.3303 | $8,181.655 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1635.3462 | $8,176.735 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1697.2091 | $8,486.055 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1697.2091 | $8,486.055 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1635.3462 | $8,176.735 units |
|
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1697.2091 | $8,486.055 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Idaho and Utah — 10 plans, 10 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1552.6463 | $7,763.235 units |
|
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1552.6463 | $7,763.235 units |
|
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1552.6463 | $7,763.235 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1552.6463 | $7,763.235 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Maine and New Hampshire — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.1200 | $7,970.605 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.1200 | $7,970.605 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1594.0102 | $7,970.055 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Virginia — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1603.5453 | $8,017.735 units |
|
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1603.5453 | $8,017.735 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1692.0320 | $8,460.165 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1772.4792 | $8,862.405 units |
|
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1692.0320 | $8,460.165 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1772.4792 | $8,862.405 units |
|
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1612.3794 | $8,061.905 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Alaska — 9 plans, 9 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1718.7322 | $8,593.665 units |
|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1715.5533 | $8,577.775 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1806.3716 | $9,031.865 units |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1806.3716 | $9,031.865 units |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1718.7322 | $8,593.665 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1872.7549 | $9,363.775 units |
|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1891.6430 | $9,458.225 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1872.7549 | $9,363.775 units |
|
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1806.3716 | $9,031.865 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Hawaii — 8 plans, 8 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1803.6336 | $9,018.175 units |
|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1740.9929 | $8,704.965 units |
|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1814.4336 | $9,072.175 units |
|
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1600.6000 | $8,003.005 units |
|
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1600.6000 | $8,003.005 units |
|
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 5Specialty Tier | 26% | — | $1740.9929 | $8,704.965 units |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $1740.9929 | $8,704.965 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 5Specialty Tier | 31% | — | $1803.6336 | $9,018.175 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Puerto Rico — 3 plans, 3 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1715.3216 | $8,576.615 units |
|
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $1715.5533 | $8,577.775 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $1879.8887 | $9,399.445 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
American Samoa — 1 plan, 1 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $1879.8887 | $9,399.445 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Guam — 1 plan, 1 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $1879.8887 | $9,399.445 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Northern Mariana Islands — 1 plan, 1 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$32.10/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $1879.8887 | $9,399.445 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
U.S. Virgin Islands — 1 plan, 1 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $1879.8887 | $9,399.445 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.