MedicarePartD.guide

A non-government resource built from CMS public data

TELMISARTAN 20 mg Tablet

Package: 30 TABLET in 1 BOTTLE (67877-482-30). NDC 67877048230.

Plans covering it
333
across 39 regions checked
Lowest tier
1
lower tiers cost less
Plans with restrictions
268
prior auth, step therapy or quantity limit

Coverage by region

Covered by at least one plan in 39 of 39 CMS regions.

RegionPlans coveringTiersLowest 30-day costRestrictions
New Jersey11 of 121–4$0.009 of 11 plans
Pennsylvania and West Virginia11 of 121–3$0.007 of 11 plans
North Carolina11 of 121–4$0.009 of 11 plans
Alabama and Tennessee11 of 121–4$0.009 of 11 plans
Michigan11 of 121–4$0.009 of 11 plans
Illinois11 of 121–4$0.009 of 11 plans
Arkansas11 of 121–4$0.009 of 11 plans
Texas11 of 121–4$0.009 of 11 plans
Kansas11 of 121–4$0.0010 of 11 plans
California11 of 121–4$0.007 of 11 plans
Connecticut, Massachusetts, Rhode Island and Vermont10 of 111–3$0.009 of 10 plans
South Carolina10 of 111–6$0.007 of 10 plans
Oklahoma10 of 111–3$0.008 of 10 plans
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming10 of 111–3$0.008 of 10 plans
New Mexico10 of 111–4$0.009 of 10 plans
New York9 of 101–4$0.007 of 9 plans
Delaware, DC and Maryland9 of 101–4$0.007 of 9 plans
Georgia9 of 101–4$0.007 of 9 plans
Florida9 of 101–6$0.009 of 9 plans
Ohio9 of 101–4$0.007 of 9 plans
Indiana and Kentucky9 of 101–3$0.007 of 9 plans
Wisconsin9 of 101–3$0.007 of 9 plans
Missouri9 of 101–4$0.007 of 9 plans
Mississippi9 of 101–4$0.007 of 9 plans
Louisiana9 of 101–3$0.007 of 9 plans
Colorado9 of 101–4$0.007 of 9 plans
Arizona9 of 101–4$0.007 of 9 plans
Nevada9 of 101–4$0.007 of 9 plans
Oregon and Washington9 of 101–4$0.007 of 9 plans
Idaho and Utah9 of 101–3$0.007 of 9 plans
Maine and New Hampshire8 of 91–4$0.007 of 8 plans
Virginia8 of 91–4$0.007 of 8 plans
Alaska8 of 91–4$0.007 of 8 plans
Hawaii7 of 81–3$0.007 of 7 plans
Puerto Rico3 of 31–3$0.001 of 3 plans
American Samoa1 of 13—1 of 1 plans
Guam1 of 13—1 of 1 plans
Northern Mariana Islands1 of 13—1 of 1 plans
U.S. Virgin Islands1 of 13—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 — 11 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0843$0.253 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5372$1.613 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1292—None
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1735—None
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5336$1.603 units
  • Quantity limit 3 per 30 days
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible2Generic$6.00$9.00$0.2237$0.673 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8501$2.553 units
  • Quantity limit 3 per 30 days
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2237$0.673 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2325$0.703 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2356$0.713 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6027$1.813 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1025$0.313 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4996$1.503 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0716$0.213 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1483—None
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1765—None
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4914$1.473 units
  • Quantity limit 3 per 30 days
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible1Preferred Generic$0.00$0.00$0.1400—None
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible1Preferred Generic25%25%$0.1400—None
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8614$2.583 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible3Preferred Brand16%16%$0.2335$0.703 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible3Preferred Brand16%16%$0.2362$0.713 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1260$0.383 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5320$1.603 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1539—None
HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2026—None
Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5191$1.563 units
  • Quantity limit 3 per 30 days
Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible2Generic$6.00$18.00$0.2833$0.853 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9141$2.743 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2272$0.683 units
  • Quantity limit 3 per 30 days
Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible3Preferred Brand20%20%$0.2833$0.853 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2272$0.683 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6198$1.863 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1385$0.423 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5152$1.553 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1746—None
HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2172—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5013$1.503 units
  • Quantity limit 3 per 30 days
BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible2Generic$12.00$24.00$0.3046$0.913 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9311$2.793 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2308$0.693 units
  • Quantity limit 3 per 30 days
BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible3Preferred Brand19%19%$0.3046$0.913 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2312$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6074$1.823 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1095$0.333 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.1914—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4921$1.483 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1513—None
Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible1Preferred Generic$1.00$3.00$0.2998$3.6012 units
  • Quantity limit 36 per 90 days
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4834$1.453 units
  • Quantity limit 3 per 30 days
Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible1Preferred Generic$1.00$2.00$0.2998$3.6012 units
  • Quantity limit 36 per 90 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9458$2.843 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2311$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible3Preferred Brand18%18%$0.2320$0.703 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6356$1.913 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0809$0.243 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4881$1.463 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1085—None
HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1952—None
Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4825$1.453 units
  • Quantity limit 3 per 30 days
Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible2Generic$1.00$3.00$0.2374$0.713 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$1.0024$3.013 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2357$0.713 units
  • Quantity limit 3 per 30 days
Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible3Preferred Brand20%20%$0.2450$0.733 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2370$0.713 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6200$1.863 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2247$0.673 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.2463—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4844$1.453 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2049—None
Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4601$1.383 units
  • Quantity limit 3 per 30 days
BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2411$0.723 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8376$2.513 units
  • Quantity limit 3 per 30 days
BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible3Preferred Brand19%19%$0.2411$0.723 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2278$0.683 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible3Preferred Brand16%16%$0.2278$0.683 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4688$1.413 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1343$0.403 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5052$1.523 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1549—None
HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2031—None
Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4894$1.473 units
  • Quantity limit 3 per 30 days
Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible2Generic$1.00$3.00$0.3324$1.003 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9854$2.963 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2307$0.693 units
  • Quantity limit 3 per 30 days
Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.2984$0.903 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible3Preferred Brand18%18%$0.2307$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6746$2.023 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 10 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible1Preferred Generic5%5%$0.2150—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1566$0.473 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4711$1.413 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4550$1.363 units
  • Quantity limit 3 per 30 days
Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible2Generic$0.00$0.00$0.3226$0.973 units
  • Quantity limit 3 per 30 days
Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible2Generic$0.00$0.00$0.3383$1.013 units
  • Quantity limit 3 per 30 days
Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.3383$1.013 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9783$2.933 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2505$0.753 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2539$0.763 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6512$1.953 units
  • Quantity limit 3 per 30 days

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 — 11 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.1776—None
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0946$0.283 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1363—None
Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5189$1.563 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5134$1.543 units
  • Quantity limit 3 per 30 days
Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible2Generic$7.00$14.00$0.3932—None
Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible3Preferred Brand25%25%$0.7982$2.393 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2312$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2332$0.703 units
  • Quantity limit 3 per 30 days
Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.3932—None
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6005$1.803 units
  • Quantity limit 3 per 30 days

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

Connecticut, Massachusetts, Rhode Island and Vermont — 10 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0589$0.183 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0659$0.203 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5618$1.693 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5582$1.673 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1579—None
Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible1Preferred Generic$1.00$1.00$1.3232$3.973 units
  • Quantity limit 3 per 30 days
Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible3Preferred Brand17%17%$1.3232$3.973 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8677$2.603 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2353$0.713 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2380$0.713 units
  • Quantity limit 3 per 30 days

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 — 10 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1195$0.363 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5411$1.623 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1586—None
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5285$1.593 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1981—None
Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9113$2.733 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2275$0.683 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2275$0.683 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6572$1.973 units
  • Quantity limit 3 per 30 days
BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible6Select Care Drugs$5.00$12.50$1.0609—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 — 10 plans, 8 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2277$0.683 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5189$1.563 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1884—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4942$1.483 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2461—None
Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible2Generic$1.00$3.00$0.4052$1.223 units
  • Quantity limit 3 per 30 days
Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand16%16%$0.3577$1.073 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8609$2.583 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2290$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible3Preferred Brand16%16%$0.2293$0.693 units
  • Quantity limit 3 per 30 days

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 — 10 plans, 8 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1496$0.453 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4653$1.403 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0901$0.273 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1607—None
Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4539$1.363 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2060—None
AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2330$0.703 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9347$2.803 units
  • Quantity limit 3 per 30 days
MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible3Preferred Brand22%22%$0.3608$1.083 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible3Preferred Brand18%18%$0.2332$0.703 units
  • Quantity limit 3 per 30 days

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

New Mexico — 10 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1832$0.553 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.2386—None
Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5084$1.533 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4883$1.463 units
  • Quantity limit 3 per 30 days
Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible2Generic$4.00$12.00$0.3526$1.063 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8865$2.663 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand16%16%$0.2367$0.713 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible3Preferred Brand16%16%$0.2376$0.713 units
  • Quantity limit 3 per 30 days
Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.3384$1.023 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6307$1.893 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible1Preferred Generic5%5%$0.1837—None
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1091$0.333 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1465—None
Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4950$1.483 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4918$1.483 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.7074$2.123 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2319$0.703 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2332$0.703 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.4515$1.353 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5241$1.573 units
  • Quantity limit 3 per 30 days
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0677$0.203 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1756—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1309—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5185$1.563 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9369$2.813 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2297$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2304$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6107$1.833 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1279$0.383 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5078$1.523 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1819—None
Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4956$1.493 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2100—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9164$2.753 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2307$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible3Preferred Brand16%16%$0.2316$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6320$1.903 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 9 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0833$0.253 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5654$1.703 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5575$1.673 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9831$2.953 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2291$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2296$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6985$2.103 units
  • Quantity limit 3 per 30 days
BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible6Select Care Drugs$3.00$9.00$0.2044$0.613 units
  • Quantity limit 3 per 30 days
BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible6Select Care Drugs$0.00$0.00$0.2044$0.613 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1050$0.323 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4886$1.473 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1530—None
HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1818—None
Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4790$1.443 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible3Preferred Brand25%25%$1.0057$3.023 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2327$0.703 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2334$0.703 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6857$2.063 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1219$0.373 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5135$1.543 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0708$0.213 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1579—None
HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1915—None
Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5018$1.513 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8985$2.703 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2356$0.713 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible3Preferred Brand18%18%$0.2356$0.713 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1476$0.443 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.2241—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5354$1.613 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0728$0.223 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1553—None
Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5200$1.563 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9381$2.813 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2272$0.683 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2272$0.683 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1532$0.463 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5374$1.613 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1551—None
HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2062—None
Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5213$1.563 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9148$2.743 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2300$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2314$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6317$1.903 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1884$0.573 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4924$1.483 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2309—None
HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1881—None
Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4743$1.423 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8265$2.483 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2303$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible3Preferred Brand16%16%$0.2320$0.703 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.5500$1.653 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1883$0.563 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5379$1.613 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0742$0.223 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2304—None
HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1750—None
Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5168$1.553 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8601$2.583 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible3Preferred Brand16%16%$0.2303$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2323$0.703 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1336$0.403 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4771$1.433 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2211—None
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1683—None
Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4600$1.383 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible3Preferred Brand25%25%$1.0391$3.123 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible3Preferred Brand19%19%$0.2279$0.683 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2286$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6940$2.083 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0935$0.283 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.1962—None
Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5369$1.613 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1209—None
Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5267$1.583 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$1.0300$3.093 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.2317$0.703 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible3Preferred Brand18%18%$0.2321$0.703 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.7311$2.193 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1017$0.313 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5389$1.623 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1362—None
HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1959—None
Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5267$1.583 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible3Preferred Brand25%25%$1.0106$3.033 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.2272$0.683 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible3Preferred Brand18%18%$0.2273$0.683 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.7112$2.133 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0943$0.283 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.2066—None
Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4439$1.333 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1482—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4357$1.313 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9887$2.973 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2309$0.693 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible3Preferred Brand16%16%$0.2313$0.693 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6509$1.953 units
  • Quantity limit 3 per 30 days

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 — 9 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1509$0.453 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4334$1.303 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0772$0.233 units
  • Quantity limit 3 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1665—None
Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4199$1.263 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2302—None
Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.8812$2.643 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2321$0.703 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2337$0.703 units
  • Quantity limit 3 per 30 days

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

Maine and New Hampshire — 8 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0921$0.283 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.1947—None
Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5307$1.593 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5208$1.563 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9893$2.973 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2280$0.683 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible3Preferred Brand15%15%$0.2280$0.683 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.5678$1.703 units
  • Quantity limit 3 per 30 days

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

Virginia — 8 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1131$0.343 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5327$1.603 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5201$1.563 units
  • Quantity limit 3 per 30 days
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1972—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.9519$2.863 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible3Preferred Brand17%17%$0.2277$0.683 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2283$0.683 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.6481$1.943 units
  • Quantity limit 3 per 30 days

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

Alaska — 8 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible1Preferred Generic5%5%$0.3219—None
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.4193$1.263 units
  • Quantity limit 3 per 30 days
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2166$0.653 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.4079$1.223 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$1.1062$3.323 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible3Preferred Brand19%19%$0.3177$0.953 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible3Preferred Brand18%18%$0.3177$0.953 units
  • Quantity limit 3 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible4Non-Preferred Drug33%33%$0.7197$2.163 units
  • Quantity limit 3 per 30 days

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 — 7 plans, 7 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0701$0.213 units
  • Quantity limit 3 per 30 days
Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0670$0.203 units
  • Quantity limit 3 per 30 days
Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible1Preferred Generic$0.00$0.00$0.5454$1.643 units
  • Quantity limit 3 per 30 days
Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.5422$1.633 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand16%16%$0.2271$0.683 units
  • Quantity limit 3 per 30 days
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.7853$2.363 units
  • Quantity limit 3 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible3Preferred Brand17%17%$0.2271$0.683 units
  • Quantity limit 3 per 30 days

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

Puerto Rico — 3 plans, 1 with restrictions
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1384—None
HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.2176—None
AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible3Preferred Brand25%25%$0.2155$0.653 units
  • Quantity limit 3 per 30 days

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
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4762$1.433 units
  • Quantity limit 3 per 30 days

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
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible3Preferred Brand25%25%$0.2336$0.703 units
  • Quantity limit 3 per 30 days

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
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$32.10/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4762$1.433 units
  • Quantity limit 3 per 30 days

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
PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible3Preferred Brand25%25%$0.2336$0.703 units
  • Quantity limit 3 per 30 days

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.