LEVOTHYROXINE SODIUM .3 mg Tablet
Package: 100 TABLET in 1 BOTTLE (68180-976-01). NDC 68180097601.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 1
- lower tiers cost less
- Plans with restrictions
- 0
- 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 | 1–2 | $0.00 | none |
| Pennsylvania and West Virginia | 12 of 12 | 1–2 | $0.00 | none |
| North Carolina | 12 of 12 | 1–2 | $0.00 | none |
| Alabama and Tennessee | 12 of 12 | 1–2 | $0.00 | none |
| Michigan | 12 of 12 | 1–2 | $0.00 | none |
| Illinois | 12 of 12 | 1–2 | $0.00 | none |
| Arkansas | 12 of 12 | 1–2 | $0.00 | none |
| Texas | 12 of 12 | 1–2 | $0.00 | none |
| Kansas | 12 of 12 | 1–2 | $0.00 | none |
| California | 12 of 12 | 1–2 | $0.00 | none |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 1–2 | $0.00 | none |
| South Carolina | 11 of 11 | 1–2 | $0.00 | none |
| Oklahoma | 11 of 11 | 1–2 | $0.00 | none |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 1–2 | $0.00 | none |
| New Mexico | 11 of 11 | 1–2 | $0.00 | none |
| New York | 10 of 10 | 1–2 | $0.00 | none |
| Delaware, DC and Maryland | 10 of 10 | 1–2 | $0.00 | none |
| Georgia | 10 of 10 | 1–2 | $0.00 | none |
| Florida | 10 of 10 | 1–2 | $0.00 | none |
| Ohio | 10 of 10 | 1–2 | $0.00 | none |
| Indiana and Kentucky | 10 of 10 | 1–2 | $0.00 | none |
| Wisconsin | 10 of 10 | 1–2 | $0.00 | none |
| Missouri | 10 of 10 | 1–2 | $0.00 | none |
| Mississippi | 10 of 10 | 1–2 | $0.00 | none |
| Louisiana | 10 of 10 | 1–2 | $0.00 | none |
| Colorado | 10 of 10 | 1–2 | $0.00 | none |
| Arizona | 10 of 10 | 1–2 | $0.00 | none |
| Nevada | 10 of 10 | 1–2 | $0.00 | none |
| Oregon and Washington | 10 of 10 | 1–2 | $0.00 | none |
| Idaho and Utah | 10 of 10 | 1–2 | $0.00 | none |
| Maine and New Hampshire | 9 of 9 | 1–2 | $0.00 | none |
| Virginia | 9 of 9 | 1–2 | $0.00 | none |
| Alaska | 9 of 9 | 1–2 | $0.00 | none |
| Hawaii | 8 of 8 | 1–2 | $0.00 | none |
| Puerto Rico | 3 of 3 | 1–2 | $0.00 | none |
| American Samoa | 1 of 1 | 1 | — | none |
| Guam | 1 of 1 | 1 | — | none |
| Northern Mariana Islands | 1 of 1 | 1 | — | none |
| U.S. Virgin Islands | 1 of 1 | 1 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3225 | — | None |
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1206 | — | None |
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3257 | — | None |
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2328 | — | None |
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2189 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2341 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0689 | — | None |
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3225 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3896 | — | None |
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2189 | — | None |
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3156 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1289 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3134 | — | None |
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1544 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3220 | — | None |
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0895 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2428 | — | None |
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2161 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3826 | — | None |
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3134 | — | None |
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1340 | — | None |
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 1Preferred Generic | 25% | 25% | $0.1340 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3565 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1293 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1624 | — | None |
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3299 | — | None |
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3405 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2118 | — | None |
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3159 | — | None |
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 1Preferred Generic | $5.00 | $15.00 | $0.2946 | — | None |
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0740 | — | None |
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3299 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3481 | — | None |
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 1Preferred Generic | $3.00 | $9.00 | $0.2946 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3689 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1353 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3173 | — | None |
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1499 | — | None |
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3248 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2038 | — | None |
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $4.00 | $0.2876 | — | None |
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3050 | — | None |
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0792 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3173 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3373 | — | None |
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2876 | — | None |
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3411 | — | None |
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1414 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1403 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3108 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3174 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2108 | — | None |
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2795 | — | None |
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0675 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3552 | — | None |
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3108 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3337 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1318 | — | None |
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $0.2510 | — | None |
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 2Generic | $5.00 | $10.00 | $0.2510 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Illinois — 12 plans
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1096 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3302 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3364 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1546 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3970 | — | None |
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2625 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0674 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2724 | — | None |
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3302 | — | None |
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2509 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3771 | — | None |
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1191 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2118 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2978 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3114 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3384 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $24.00 | $0.1843 | — | None |
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0864 | — | None |
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2978 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $39.00 | $0.3142 | — | None |
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.4963 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3842 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1548 | — | None |
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $0.4963 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1280 | — | None |
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3345 | — | None |
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3258 | — | None |
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3030 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1754 | — | None |
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0693 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2635 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2884 | — | None |
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3258 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2703 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3719 | — | None |
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1231 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3168 | — | None |
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3323 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1608 | — | None |
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2920 | — | None |
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3014 | — | None |
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3323 | — | None |
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1095 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1982 | — | None |
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2920 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3380 | — | None |
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1345 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $9.00 | $27.00 | $0.3916 | — | 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
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1149 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2675 | — | None |
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0702 | — | None |
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3478 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2223 | — | None |
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3415 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3556 | — | None |
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3415 | — | None |
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.6366 | — | None |
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.6366 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1211 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3527 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3697 | — | None |
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0679 | — | None |
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0939 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2698 | — | None |
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3728 | — | None |
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3697 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.4213 | — | None |
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $6.00 | $0.4764 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3418 | — | None |
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.0998 | — | None |
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 2Generic | $7.00 | $14.00 | $0.4764 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1424 | — | None |
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 1Preferred Generic | $1.00 | $0.00 | $0.3428 | — | None |
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3522 | — | None |
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2731 | — | None |
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0674 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2325 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3718 | — | None |
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 1Preferred Generic | $12.00 | $30.00 | $0.6371 | — | None |
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3428 | — | None |
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3690 | — | None |
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1240 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3242 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $1.00 | $0.00 | $0.3026 | — | None |
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2673 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3187 | — | None |
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3971 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1946 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3026 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3321 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3529 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.4229 | — | None |
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1802 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2912 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1829 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1719 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3002 | — | None |
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1063 | — | None |
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2803 | — | None |
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2994 | — | None |
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2912 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2982 | — | None |
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3792 | — | None |
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1360 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1565 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3522 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1590 | — | None |
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3652 | — | None |
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3522 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2794 | — | None |
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0626 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2819 | — | None |
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2900 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3980 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1316 | — | 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
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1211 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2233 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2332 | — | None |
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0784 | — | None |
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3221 | — | None |
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3267 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3840 | — | None |
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3221 | — | None |
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1242 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3235 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Delaware, DC and Maryland — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3219 | — | None |
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3257 | — | None |
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1085 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2138 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2568 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3436 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0682 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3219 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3241 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1332 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Georgia — 10 plans
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1545 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3195 | — | None |
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3286 | — | None |
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2778 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2130 | — | None |
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0772 | — | None |
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3195 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3449 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3684 | — | None |
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1400 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1090 | — | None |
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3609 | — | None |
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3555 | — | None |
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0681 | — | None |
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 1Preferred Generic | $3.00 | $9.00 | $0.2237 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1893 | — | None |
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3555 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3139 | — | None |
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2237 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3498 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3117 | — | None |
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1372 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3194 | — | None |
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2455 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2360 | — | None |
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0823 | — | None |
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3117 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3810 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3630 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1256 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3107 | — | None |
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1760 | — | None |
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3208 | — | None |
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0921 | — | None |
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2817 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2312 | — | None |
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3107 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3604 | — | None |
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3654 | — | None |
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1396 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1676 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3267 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3371 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1635 | — | None |
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1062 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3908 | — | None |
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3267 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2905 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3680 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1424 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1986 | — | None |
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3204 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3344 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3415 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1930 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0783 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3228 | — | None |
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3204 | — | None |
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.4023 | — | None |
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1416 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Mississippi — 10 plans
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1807 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3009 | — | None |
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3090 | — | None |
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3027 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2050 | — | None |
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3009 | — | None |
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0783 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3483 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3302 | — | None |
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1479 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.3135 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2028 | — | None |
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3258 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2003 | — | None |
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0870 | — | None |
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3156 | — | None |
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3135 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3358 | — | None |
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3688 | — | None |
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1510 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2004 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2983 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3157 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3774 | — | None |
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0964 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1531 | — | None |
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2983 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2625 | — | None |
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.4402 | — | None |
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1435 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1329 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $0.00 | $0.3467 | — | None |
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3583 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2226 | — | None |
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3527 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0659 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3670 | — | None |
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3467 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.4099 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1226 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Nevada — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3640 | — | None |
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1268 | — | None |
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3755 | — | None |
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3022 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2125 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0597 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3424 | — | None |
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3640 | — | None |
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.4058 | — | None |
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1128 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oregon and Washington — 10 plans
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1729 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2859 | — | None |
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2974 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1773 | — | None |
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3139 | — | None |
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0826 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2859 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2849 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3900 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1401 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.2658 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1748 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2734 | — | None |
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0992 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2589 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1987 | — | None |
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2658 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3222 | — | None |
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3371 | — | None |
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1543 | — | 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
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1669 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3240 | — | None |
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3366 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1880 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0718 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.2920 | — | None |
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3240 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.4007 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1492 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Virginia — 9 plans
| 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 | 1Preferred Generic | $0.00 | $0.00 | $0.1836 | — | None |
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3283 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3429 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.2050 | — | None |
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0677 | — | None |
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3283 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3348 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.4021 | — | None |
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1404 | — | 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
| 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 | 1Preferred Generic | $2.00 | $0.00 | $0.2608 | — | None |
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2667 | — | None |
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.1465 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.1902 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0687 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.3114 | — | None |
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.2608 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3155 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $0.1386 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Hawaii — 8 plans
| 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 | 1Preferred Generic | $2.00 | $6.00 | $0.3252 | — | None |
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 1Preferred Generic | $3.00 | $0.00 | $0.3747 | — | None |
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $6.00 | $0.0909 | — | None |
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.0256 | — | None |
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3757 | — | None |
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $0.3747 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 1Preferred Generic | $5.00 | $0.00 | $0.4741 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3448 | — | 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 | 1Preferred Generic | $0.00 | $0.00 | $0.4035 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 1Preferred Generic | 25% | 25% | $0.2965 | — | None |
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $0.1399 | — | 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 | 1Preferred Generic | 25% | 25% | $0.4170 | — | 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 | 1Preferred Generic | 25% | 25% | $0.4170 | — | 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 | 1Preferred Generic | 25% | 25% | $0.4170 | — | 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 | 1Preferred Generic | 25% | 25% | $0.2218 | — | 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.