ETONOGESTREL/ETHINYL ESTRADIOL .12/.015 mg/d Insert, Extended Release
Also known as Etonogestrel And Ethinyl Estradiol. Package: 3 POUCH in 1 BOX (66993-605-36) / 21 d in 1 POUCH (66993-605-81). NDC 66993060536.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 3
- lower tiers cost less
- Plans with restrictions
- 104
- 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 | 3 | $45.00 | 3 of 12 plans |
| Pennsylvania and West Virginia | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| North Carolina | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| Alabama and Tennessee | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| Michigan | 12 of 12 | 3 | $45.00 | 5 of 12 plans |
| Illinois | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| Arkansas | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| Texas | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| Kansas | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| California | 12 of 12 | 3 | $45.00 | 3 of 12 plans |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 3 | $30.00 | 3 of 11 plans |
| South Carolina | 11 of 11 | 3 | $45.00 | 3 of 11 plans |
| Oklahoma | 11 of 11 | 3 | $45.00 | 3 of 11 plans |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 3 | $45.00 | 3 of 11 plans |
| New Mexico | 11 of 11 | 3 | $45.00 | 3 of 11 plans |
| New York | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Delaware, DC and Maryland | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Georgia | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Florida | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Ohio | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Indiana and Kentucky | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Wisconsin | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Missouri | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Mississippi | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Louisiana | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Colorado | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Arizona | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Nevada | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Oregon and Washington | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Idaho and Utah | 10 of 10 | 3 | $45.00 | 3 of 10 plans |
| Maine and New Hampshire | 9 of 9 | 3 | $45.00 | 3 of 9 plans |
| Virginia | 9 of 9 | 3 | $45.00 | 3 of 9 plans |
| Alaska | 9 of 9 | 3 | $45.00 | 3 of 9 plans |
| Hawaii | 8 of 8 | 3 | $45.00 | 3 of 8 plans |
| Puerto Rico | 3 of 3 | 3 | — | none |
| American Samoa | 1 of 1 | 3 | — | none |
| Guam | 1 of 1 | 3 | — | none |
| Northern Mariana Islands | 1 of 1 | 3 | — | none |
| U.S. Virgin Islands | 1 of 1 | 3 | — | none |
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, 3 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 | 3Preferred Brand | 25% | 20% | $88.2393 | $88.241 unit |
|
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $79.2942 | — | None |
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $79.2942 | — | None |
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 3Preferred Brand | 19% | 14% | $88.2393 | $88.241 unit |
|
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $87.2463 | — | None |
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $133.2737 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $70.3609 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $43.0135 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $81.2826 | — | None |
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $88.2393 | $88.241 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $66.1504 | — | None |
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 3Preferred Brand | 20% | 20% | $133.2737 | — | 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 — 12 plans, 3 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 | 3Preferred Brand | 25% | 20% | $98.3313 | $98.331 unit |
|
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $83.1132 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $83.1139 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $98.3313 | $98.331 unit |
|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $58.5659 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $71.8185 | — | None |
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $99.7228 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $85.7670 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $68.5997 | — | None |
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $98.3313 | $98.331 unit |
|
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 3Preferred Brand | 25% | 25% | $103.0767 | — | None |
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $103.1667 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
North Carolina — 12 plans, 3 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 | 3Preferred Brand | 25% | 25% | $80.8979 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $80.9052 | — | None |
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $95.8936 | $95.891 unit |
|
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $95.8936 | $95.891 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $73.7796 | — | None |
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $82.8896 | — | None |
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $136.5678 | — | None |
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $36.1840 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $65.9566 | — | None |
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $95.8936 | $95.891 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $72.9438 | — | None |
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $135.00 | $136.5678 | — | 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 — 12 plans, 3 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 | 3Preferred Brand | 25% | 20% | $90.5084 | $90.511 unit |
|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $91.7739 | — | None |
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $91.7776 | — | None |
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $90.5435 | $90.541 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $72.7514 | — | None |
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $136.2884 | — | None |
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $86.6537 | — | None |
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $74.0422 | — | None |
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $49.1968 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $90.4887 | $90.491 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $69.2384 | — | None |
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 3Preferred Brand | $47.00 | $94.00 | $136.2884 | — | 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 — 12 plans, 5 with restrictions
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $95.6076 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $95.6073 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $73.9113 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $85.7849 | $85.781 unit |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $85.7849 | $85.781 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $72.6274 | — | None |
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $80.1636 | — | None |
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $73.5306 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $66.1793 | — | None |
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $70.2277 | $70.231 unit |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $85.7849 | $85.781 unit |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 3Preferred Brand | 24% | 24% | $70.2277 | $70.231 unit |
|
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, 3 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 | 3Preferred Brand | 25% | 25% | $85.5740 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $85.5736 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $107.2583 | $107.261 unit |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $107.2583 | $107.261 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $69.2168 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $123.5687 | — | None |
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $134.5776 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $40.3315 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $68.3132 | — | None |
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $98.2999 | — | None |
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $107.2583 | $107.261 unit |
|
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $133.6276 | — | 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 — 12 plans, 3 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 | 3Preferred Brand | 25% | 25% | $78.5417 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $78.5408 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $70.4371 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $81.1979 | $81.201 unit |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $81.1979 | $81.201 unit |
|
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $50.4772 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $71.8562 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $70.0541 | — | None |
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $43.2671 | — | None |
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $81.1979 | $81.201 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $65.5303 | — | None |
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 3Preferred Brand | 20% | 20% | $50.4772 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Texas — 12 plans, 3 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 | 3Preferred Brand | 25% | 25% | $87.1440 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $87.7015 | — | None |
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $89.3588 | $89.361 unit |
|
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $89.2533 | $89.251 unit |
|
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $83.4059 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $70.3913 | — | None |
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $50.9251 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $137.3552 | — | None |
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $71.6763 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $67.7896 | — | None |
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $89.1939 | $89.191 unit |
|
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $137.3552 | — | 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.
Kansas — 12 plans, 3 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 | 3Preferred Brand | 20% | 20% | $135.2823 | — | None |
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $134.9586 | — | None |
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $89.9833 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $106.3741 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $106.3741 | — | None |
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $85.3898 | $85.391 unit |
|
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $85.3898 | $85.391 unit |
|
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 3Preferred Brand | 20% | 20% | $134.9586 | — | None |
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $70.7844 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $75.7709 | — | None |
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $85.3898 | $85.391 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $69.6297 | — | 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 — 12 plans, 3 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 | 3Preferred Brand | 25% | 25% | $70.1624 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $82.2488 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $82.2545 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $82.6625 | — | None |
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $41.1743 | — | None |
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $92.0093 | $92.011 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $71.6388 | — | None |
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $92.0093 | $92.011 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $70.1816 | — | None |
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $92.0093 | $92.011 unit |
|
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $130.8556 | — | None |
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 3Preferred Brand | 19% | 19% | $130.8556 | — | 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 — 11 plans, 3 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 | 3Preferred Brand | 25% | 20% | $94.4860 | $94.491 unit |
|
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $80.3349 | — | None |
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $50.4632 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $80.1958 | — | None |
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $84.5791 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $75.3819 | — | None |
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $94.4860 | $94.491 unit |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $94.4860 | $94.491 unit |
|
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $62.0674 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $75.2049 | — | None |
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 3Preferred Brand | $30.00 | $60.00 | $50.4632 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
South Carolina — 11 plans, 3 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 | 3Preferred Brand | 25% | 25% | $80.3294 | — | None |
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $80.3377 | — | None |
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $96.9072 | $96.911 unit |
|
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 3Preferred Brand | 19% | 14% | $96.9072 | $96.911 unit |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $80.9988 | — | None |
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $34.9365 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $74.1026 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $74.1026 | — | None |
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $101.8702 | — | None |
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $96.9072 | $96.911 unit |
|
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $63.2556 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oklahoma — 11 plans, 3 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 | 3Preferred Brand | 16% | 16% | $135.2021 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $87.6369 | $87.641 unit |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $83.0882 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $83.0896 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $87.6369 | $87.641 unit |
|
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $86.8736 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $70.8248 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $87.6369 | $87.641 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $67.0880 | — | None |
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $81.6949 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $134.4021 | — | 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 — 11 plans, 3 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 | 3Preferred Brand | 25% | 20% | $93.7395 | $93.741 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $72.1243 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $94.0191 | — | None |
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $94.0193 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $93.8746 | $93.871 unit |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $65.8651 | — | None |
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $101.5853 | — | None |
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $135.2074 | — | None |
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $93.6634 | $93.661 unit |
|
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $89.3370 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $68.2462 | — | 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 — 11 plans, 3 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 | 3Preferred Brand | 25% | 25% | $97.1552 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $97.1530 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $88.0283 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $101.7244 | $101.721 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $72.4667 | — | None |
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $101.7244 | $101.721 unit |
|
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $101.7244 | $101.721 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $68.7859 | — | None |
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $48.8567 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 3Preferred Brand | 14% | 14% | $137.6429 | — | None |
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $137.6429 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 25% | $77.9497 | — | None |
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $83.1281 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $81.3034 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $86.6331 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $70.0026 | — | None |
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $48.7312 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $87.6273 | $87.631 unit |
|
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 3Preferred Brand | 17% | 12% | $87.6273 | $87.631 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $66.4677 | — | None |
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $87.6273 | $87.631 unit |
|
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, 3 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 | 3Preferred Brand | 25% | 20% | $88.3950 | $88.391 unit |
|
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $88.3950 | $88.391 unit |
|
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $79.9400 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $79.9422 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $76.1291 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $70.7817 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $82.8473 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $67.7489 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $43.2299 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $88.3950 | $88.391 unit |
|
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, 3 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 | 3Preferred Brand | 25% | 25% | $93.7200 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $93.7165 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $86.9116 | $86.911 unit |
|
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $86.9116 | $86.911 unit |
|
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $84.7223 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $70.5314 | — | None |
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $51.7838 | — | None |
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $86.9116 | $86.911 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $66.4713 | — | None |
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $74.6079 | — | 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, 3 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 | 3Preferred Brand | 25% | 25% | $81.3936 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $81.7629 | — | None |
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $95.9666 | $95.971 unit |
|
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $95.9666 | $95.971 unit |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $39.8412 | — | None |
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $137.8367 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $69.1725 | — | None |
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $95.9666 | $95.971 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $68.7788 | — | None |
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $137.8367 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 20% | $85.3425 | $85.341 unit |
|
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $110.1175 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $110.1181 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $85.3425 | $85.341 unit |
|
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $92.5889 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $72.9585 | — | None |
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $66.0404 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $82.2931 | — | None |
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $85.3425 | $85.341 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $65.8054 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 20% | $84.9935 | $84.991 unit |
|
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $109.5029 | — | None |
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $107.4694 | — | None |
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $84.9935 | $84.991 unit |
|
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $68.0625 | — | None |
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $98.6350 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $75.9981 | — | None |
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $81.9666 | — | None |
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $84.9935 | $84.991 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $68.5495 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 25% | $89.6914 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $89.6912 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $86.7524 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $99.6343 | $99.631 unit |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $99.6343 | $99.631 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $73.6423 | — | None |
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $68.3815 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $102.6841 | — | None |
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $99.6343 | $99.631 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $69.3833 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 25% | $86.9518 | — | None |
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $86.9519 | — | None |
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $90.5830 | $90.581 unit |
|
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $90.5830 | $90.581 unit |
|
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $93.6104 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $71.1647 | — | None |
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $82.3838 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $46.7302 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $66.2599 | — | None |
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $90.5830 | $90.581 unit |
|
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, 3 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 | 3Preferred Brand | 25% | 25% | $105.9056 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $105.9034 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $81.8124 | $81.811 unit |
|
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $81.8124 | $81.811 unit |
|
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $74.6178 | — | None |
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $83.4291 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $71.7757 | — | None |
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $81.8124 | $81.811 unit |
|
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $56.9173 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $64.5723 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 20% | $91.4237 | $91.421 unit |
|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $79.2330 | — | None |
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $79.2378 | — | None |
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $91.5027 | $91.501 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $72.4143 | — | None |
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $68.4246 | — | None |
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $67.2197 | — | None |
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $78.6457 | — | None |
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $91.3794 | $91.381 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $70.3476 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 25% | $105.4913 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $108.0641 | $108.061 unit |
|
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $105.4913 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $108.0641 | $108.061 unit |
|
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $97.1954 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $121.4701 | — | None |
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $57.9238 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $74.7196 | — | None |
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $108.0641 | $108.061 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $69.0793 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 25% | $96.1020 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $98.5242 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $77.3335 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 23% | 18% | $94.0448 | $94.041 unit |
|
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $94.0448 | $94.041 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $71.8070 | — | None |
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $97.9739 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $50.1366 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $68.5453 | — | None |
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $94.0448 | $94.041 unit |
|
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, 3 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 | 3Preferred Brand | 25% | 20% | $103.3975 | $103.401 unit |
|
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $95.4338 | — | None |
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $95.4326 | — | None |
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 3Preferred Brand | 18% | 13% | $103.3975 | $103.401 unit |
|
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $106.3739 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $73.4501 | — | None |
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 3Preferred Brand | 20% | 20% | $88.2156 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $49.4653 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $68.7403 | — | None |
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $103.3975 | $103.401 unit |
|
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, 3 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 | 3Preferred Brand | 25% | 25% | $101.4236 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $101.7606 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 24% | 24% | $88.4995 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $83.1734 | $83.171 unit |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $83.1734 | $83.171 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $67.5733 | — | None |
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 3Preferred Brand | 16% | 16% | $94.8851 | — | None |
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $68.6499 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $83.1734 | $83.171 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $62.6614 | — | 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 — 10 plans, 3 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 | 3Preferred Brand | 25% | 20% | $82.5033 | $82.501 unit |
|
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $113.2846 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $82.5033 | $82.501 unit |
|
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $113.2851 | — | None |
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $65.8976 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $95.1509 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $70.0546 | — | None |
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $82.5033 | $82.501 unit |
|
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 3Preferred Brand | 21% | 21% | $87.1505 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $62.0496 | — | 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 — 9 plans, 3 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 | 3Preferred Brand | 25% | 25% | $85.3870 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $87.0266 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $85.2707 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $112.4305 | $112.431 unit |
|
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $112.4305 | $112.431 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $73.2469 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $42.4526 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 3Preferred Brand | 15% | 15% | $72.4819 | — | None |
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $112.4305 | $112.431 unit |
|
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, 3 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 | 3Preferred Brand | 25% | 25% | $84.5705 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $84.5626 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $91.2427 | $91.241 unit |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $91.2427 | $91.241 unit |
|
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 3Preferred Brand | 17% | 17% | $73.6849 | — | None |
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $40.2693 | — | None |
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $91.2427 | $91.241 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $72.3736 | — | None |
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $62.3241 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Alaska — 9 plans, 3 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 | 3Preferred Brand | 25% | 25% | $150.9614 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $120.7614 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 24% | 19% | $80.1080 | $80.111 unit |
|
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $80.1080 | $80.111 unit |
|
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $150.9614 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $98.0127 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $94.1834 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 3Preferred Brand | 18% | 18% | $89.5002 | — | None |
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $80.1080 | $80.111 unit |
|
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, 3 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 | 3Preferred Brand | 16% | 16% | $73.1303 | — | None |
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 3Preferred Brand | 23% | 18% | $90.5116 | $90.511 unit |
|
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 3Preferred Brand | 19% | 19% | $89.1510 | — | None |
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $81.6182 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $81.6273 | — | None |
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $90.5116 | $90.511 unit |
|
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $90.5116 | $90.511 unit |
|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $73.1303 | — | 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 — 3 plans
| 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 | 3Preferred Brand | 17% | 17% | $88.2627 | — | None |
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 3Preferred Brand | 22% | 22% | $81.8773 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $73.2258 | — | 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
| 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 | 3Preferred Brand | 25% | 25% | $79.3752 | — | 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
| 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 | 3Preferred Brand | 25% | 25% | $79.3752 | — | 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
| 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 | 3Preferred Brand | 25% | 25% | $79.3752 | — | 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
| 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 | 3Preferred Brand | 25% | 25% | $79.3752 | — | 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.