MedicarePartD.guide

A non-government resource built from CMS public data

GABAPENTIN 800 mg Tablet

Package: 500 TABLET in 1 BOTTLE (68462-127-05). NDC 68462012705.

Plans covering it
367
across 39 regions checked
Lowest tier
2
lower tiers cost less
Plans with restrictions
294
prior auth, step therapy or quantity limit

Medicare Advantage plans in your county

Medicare Advantage drug plans in 51 states list this drug on their own formularies. Enter a ZIP code or choose a state to see every plan in a county, with its tier, cost-sharing and restrictions.

Coverage by region

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

RegionPlans coveringTiersLowest 30-day costRestrictions
New Jersey12 of 122–3$0.0010 of 12 plans
Pennsylvania and West Virginia12 of 122–3$0.0010 of 12 plans
North Carolina12 of 122–3$0.0010 of 12 plans
Alabama and Tennessee12 of 122–3$0.0010 of 12 plans
Michigan12 of 122–3$0.0010 of 12 plans
Illinois12 of 122–3$0.0010 of 12 plans
Arkansas12 of 122–3$0.0010 of 12 plans
Texas12 of 122–3$0.0010 of 12 plans
Kansas12 of 122–3$0.0010 of 12 plans
California12 of 122–3$0.0010 of 12 plans
Connecticut, Massachusetts, Rhode Island and Vermont11 of 112–3$0.009 of 11 plans
South Carolina11 of 112–3$0.009 of 11 plans
Oklahoma11 of 112–3$0.009 of 11 plans
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming11 of 112–3$0.009 of 11 plans
New Mexico11 of 112–3$0.009 of 11 plans
New York10 of 102–3$0.008 of 10 plans
Delaware, DC and Maryland10 of 102–3$0.008 of 10 plans
Georgia10 of 102–3$0.008 of 10 plans
Florida10 of 102–3$0.008 of 10 plans
Ohio10 of 102–3$0.008 of 10 plans
Indiana and Kentucky10 of 102–3$0.008 of 10 plans
Wisconsin10 of 102–3$0.008 of 10 plans
Missouri10 of 102–3$0.008 of 10 plans
Mississippi10 of 102–3$0.008 of 10 plans
Louisiana10 of 102–3$0.008 of 10 plans
Colorado10 of 102–3$0.008 of 10 plans
Arizona10 of 102–3$0.008 of 10 plans
Nevada10 of 102–3$0.008 of 10 plans
Oregon and Washington10 of 102–3$0.008 of 10 plans
Idaho and Utah10 of 102–3$0.008 of 10 plans
Maine and New Hampshire9 of 92–3$0.007 of 9 plans
Virginia9 of 92–3$0.007 of 9 plans
Alaska9 of 92–3$0.007 of 9 plans
Hawaii8 of 82–3$0.006 of 8 plans
Puerto Rico3 of 32$2.002 of 3 plans
American Samoa1 of 12—none
Guam1 of 12—none
Northern Mariana Islands1 of 12—none
U.S. Virgin Islands1 of 12—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, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2096$3.7718 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4036$4.8412 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1417$1.7012 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2117$3.8118 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1380$1.6612 units
  • Quantity limit 12 per 30 days
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible2Generic$3.00$4.50$0.2747$37.08135 units
  • Quantity limit 135 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1227—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0942$0.859 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2610$3.1312 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2096$3.7718 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2059—None
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible2Generic$6.00$9.00$0.2747$37.08135 units
  • Quantity limit 135 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1855$3.3418 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible3Preferred Brand25%25%$0.3873$4.6512 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1492$1.7912 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1892$3.4118 units
  • Quantity limit 18 per 30 days
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand19%19%$0.0961$0.869 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1267—None
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1552$1.8612 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2700$3.2412 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2042—None
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1855$3.3418 units
  • Quantity limit 18 per 30 days
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible2Generic$5.00$12.50$0.1523$1.8312 units
  • Quantity limit 12 per 30 days
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible2Generic25%25%$0.1523$1.8312 units
  • Quantity limit 12 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4120$4.9412 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1508$1.8112 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2014$3.6318 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2064$3.7218 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1218—None
HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1790$2.1512 units
  • Quantity limit 12 per 30 days
Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible2Generic$10.00$30.00$0.3196$43.15135 units
  • Quantity limit 135 per 30 days
SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0950$0.859 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3133$3.7612 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2014$3.6318 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1903—None
Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible2Generic$6.00$18.00$0.3196$43.15135 units
  • Quantity limit 135 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1941$3.4918 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.3992$4.7912 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1499$1.8012 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1983$3.5718 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1214—None
BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible2Generic$10.00$20.00$0.2907$39.24135 units
  • Quantity limit 135 per 30 days
HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1779$2.1312 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2940$3.5312 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0964$0.879 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1941$3.4918 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1885—None
BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible2Generic$12.00$24.00$0.2907$39.24135 units
  • Quantity limit 135 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1463$1.7612 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2600$3.1212 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1893$3.4118 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.1920$3.4618 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4004$4.8012 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1245—None
HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1589$1.9112 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1970—None
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0951$0.869 units
  • Quantity limit 9 per 30 days
Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible2Generic$5.00$15.00$0.1816$2.1812 units
  • Quantity limit 36 per 90 days
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1893$3.4118 units
  • Quantity limit 18 per 30 days
Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible2Generic$5.00$10.00$0.1816$2.1812 units
  • Quantity limit 36 per 90 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1415$1.7012 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2087$3.7618 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2125$3.8218 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4964$5.9612 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1092—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1634$1.9612 units
  • Quantity limit 12 per 30 days
Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible2Generic$5.00$15.00$0.3299$44.54135 units
  • Quantity limit 135 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0924$0.839 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1623—None
HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3537$4.2412 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2087$3.7618 units
  • Quantity limit 18 per 30 days
Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible2Generic$1.00$3.00$0.3277$44.24135 units
  • Quantity limit 135 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1684$2.0212 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.3326$3.9912 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1681$3.0318 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.1766$3.1818 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.3719$4.4612 units
  • Quantity limit 12 per 30 days
BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible2Generic$5.00$15.00$0.2911$3.4912 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2258$2.7112 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible2Generic$7.00$27.00$0.1251—None
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1008$0.919 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1681$3.0318 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible2Generic$10.00$54.00$0.1926—None
BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible2Generic$5.00$15.00$0.2911$3.4912 units
  • Quantity limit 12 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1457$1.7512 units
  • Quantity limit 12 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4783$5.7412 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2056$3.7018 units
  • Quantity limit 18 per 30 days
Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible2Generic$1.00$0.00$0.2000$3.6018 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1728$2.0712 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1154—None
SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0921$0.839 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible2Generic$5.00$15.00$0.3060$41.31135 units
  • Quantity limit 135 per 30 days
HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3090$3.7112 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1715—None
Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2000$3.6018 units
  • Quantity limit 18 per 30 days
Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible2Generic$1.00$3.00$0.3335$45.02135 units
  • Quantity limit 135 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 — 12 plans, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.3764$50.81135 units
  • Quantity limit 135 per 30 days
Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$6.00$0.3918$52.89135 units
  • Quantity limit 135 per 30 days
HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.3582$4.3012 units
  • Quantity limit 12 per 30 days
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4866$5.8412 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$9.00$27.00$0.1566$1.8812 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1811$3.2618 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1890$3.4018 units
  • Quantity limit 18 per 30 days
Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible2Generic$0.00$0.00$0.3918$52.89135 units
  • Quantity limit 135 per 30 days
SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1034$0.939 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1196—None
Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1811$3.2618 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1811—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, 10 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 12 of 12 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2806$3.3712 units
  • Quantity limit 12 per 30 days
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4092$4.9112 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1420$1.7012 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1396$1.6812 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0929$0.849 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2152$3.8718 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1225—None
Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible2Generic$1.00$0.00$0.2123$3.8218 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1964—None
Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2123$3.8218 units
  • Quantity limit 18 per 30 days
Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible2Generic$7.00$17.50$0.2151$25.81120 units
  • Quantity limit 4 per 1 days
Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible2Generic$7.00$14.00$0.2151$25.81120 units
  • Quantity limit 4 per 1 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 — 11 plans, 9 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2337$4.2118 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4260$5.1112 units
  • Quantity limit 12 per 30 days
Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$6.00$0.2053$2.4612 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1374$1.6512 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand19%19%$0.0907$0.829 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1267—None
Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2351$4.2318 units
  • Quantity limit 18 per 30 days
Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2337$4.2118 units
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2607$3.1312 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2013—None
Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible2Generic$7.00$14.00$0.2053$2.4612 units
  • Quantity limit 12 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 — 11 plans, 9 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4297$5.1612 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1483$1.7812 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$0.00$0.2064$3.7218 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2121$3.8218 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1769$2.1212 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0930$0.849 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1221—None
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1918—None
BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible2Generic$17.00$42.50$0.3897$5.8515 units
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2064$3.7218 units
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3111$3.7312 units
  • Quantity limit 12 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.

Oklahoma — 11 plans, 9 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$5.00$15.00$0.3419$46.16135 units
  • Quantity limit 135 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$0.00$0.1813$3.2618 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.3959$4.7512 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1725$2.0712 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1899$3.4218 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2270$2.7212 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1213—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1813$3.2618 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1875—None
HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3484$4.1812 units
  • Quantity limit 12 per 30 days
Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible2Generic$1.00$3.00$0.3887$52.47135 units
  • Quantity limit 135 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 — 11 plans, 9 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1778$3.2018 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$7.00$21.00$0.1188—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4553$5.4612 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1548$1.8612 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1826$3.2918 units
  • Quantity limit 18 per 30 days
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand19%19%$0.0993$0.899 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1767$2.1212 units
  • Quantity limit 12 per 30 days
MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible2Generic$1.00$3.00$0.3621$48.88135 units
  • Quantity limit 135 per 30 days
Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1778$3.2018 units
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2865$3.4412 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1798—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, 9 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 11 of 11 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1582$1.9012 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.4089$4.9112 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2165$3.9018 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$6.00$18.00$0.1074—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.5148$6.1812 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2256$4.0618 units
  • Quantity limit 18 per 30 days
Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2165$3.9018 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1532—None
SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0932$0.849 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible2Generic$4.00$12.00$0.3645$49.21135 units
  • Quantity limit 135 per 30 days
Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible2Generic$5.00$15.00$0.3510$47.38135 units
  • Quantity limit 135 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.2484$2.9812 units
  • Quantity limit 12 per 30 days
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible3Preferred Brand25%25%$0.3562$4.2712 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1453$1.7412 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1457$1.7512 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1259—None
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0961$0.869 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible2Generic$1.00$0.00$0.1905$3.4318 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1927$3.4718 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2041—None
Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1905$3.4318 units
  • Quantity limit 18 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2039$3.6718 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2070$3.7318 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4246$5.1012 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1415$1.7012 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2825$3.3912 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1193—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1534$1.8412 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1860—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0931$0.849 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2039$3.6718 units
  • Quantity limit 18 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1525$1.8312 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1898$3.4218 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4156$4.9912 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1948$3.5118 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1812$2.1712 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1226—None
SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0959$0.869 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1898$3.4218 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1895—None
HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2960$3.5512 units
  • Quantity limit 12 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1417$1.7012 units
  • Quantity limit 12 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4672$5.6112 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2272$4.0918 units
  • Quantity limit 18 per 30 days
Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible2Generic$1.00$0.00$0.2234$4.0218 units
  • Quantity limit 18 per 30 days
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0913$0.829 units
  • Quantity limit 9 per 30 days
BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible2Generic$14.00$42.00$0.2817$38.03135 units
  • Quantity limit 135 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1137—None
Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2234$4.0218 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1733—None
BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible2Generic$3.00$9.00$0.2817$38.03135 units
  • Quantity limit 135 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1914$3.4518 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4666$5.6012 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1451$1.7412 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1955$3.5218 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1627$1.9512 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1281—None
SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0929$0.849 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3079$3.6912 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1914$3.4518 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2019—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, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1824$3.2818 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.3632$4.3612 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1513$1.8212 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1858$3.3418 units
  • Quantity limit 18 per 30 days
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand19%19%$0.0968$0.879 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1664$2.0012 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1288—None
HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2756$3.3112 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1824$3.2818 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1980—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, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1495$1.7912 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.3401$4.0812 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2153$3.8818 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2206$3.9718 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$7.00$21.00$0.1129—None
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4511$5.4112 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.0953$0.869 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1849$2.2212 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2153$3.8818 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1686—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, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4349$5.2212 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1635$1.9612 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1924$3.4618 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2010$3.6218 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2141$2.5712 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1200—None
HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3481$4.1812 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0997$0.909 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1852—None
Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1924$3.4618 units
  • Quantity limit 18 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1602$1.9212 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1766$3.1818 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.3409$4.0912 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1822$3.2818 units
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2955$3.5512 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1953$2.3412 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible2Generic$6.00$18.00$0.1247—None
Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1766$3.1818 units
  • Quantity limit 18 per 30 days
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible3Preferred Brand18%18%$0.1011$0.919 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1964—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, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1957$3.5218 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.3690$4.4312 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1564$1.8812 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2008$3.6118 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible2Generic$6.00$18.00$0.1214—None
SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible3Preferred Brand19%19%$0.0985$0.899 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2983$3.5812 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1852$2.2212 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1957$3.5218 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1903—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, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1853$3.3418 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.5075$6.0912 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1495$1.7912 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1923$3.4618 units
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3839$4.6112 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1961$2.3512 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0946$0.859 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1130—None
Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1853$3.3418 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1582—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, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1466$1.7612 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.3732$4.4812 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$0.00$0.2194$3.9518 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.5171$6.2112 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2252$4.0518 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1243—None
HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1688$2.0312 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0900$0.819 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1948—None
Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2194$3.9518 units
  • Quantity limit 18 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2198$3.9618 units
  • Quantity limit 18 per 30 days
Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1419$1.7012 units
  • Quantity limit 12 per 30 days
Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.5025$6.0312 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2248$4.0518 units
  • Quantity limit 18 per 30 days
HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1643$1.9712 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible2Generic$6.00$18.00$0.1129—None
HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3488$4.1912 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0889$0.809 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1649—None
Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2198$3.9618 units
  • Quantity limit 18 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 — 10 plans, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1465$1.7612 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.3501$4.2012 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1774$3.1918 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4701$5.6412 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1822$3.2818 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1176—None
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1656$1.9912 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0974$0.889 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1774$3.1918 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1725—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, 8 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 10 of 10 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1696$3.0518 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4108$4.9312 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1749$3.1518 units
  • Quantity limit 18 per 30 days
Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1534$1.8412 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand19%19%$0.0962$0.879 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1890$2.2712 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1216—None
Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1696$3.0518 units
  • Quantity limit 18 per 30 days
HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3211$3.8512 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1816—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, 7 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1568$1.8812 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.3282$3.9412 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2119$3.8118 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4947$5.9412 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2179$3.9218 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1137—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0897$0.819 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1661—None
Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2119$3.8118 units
  • Quantity limit 18 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 — 9 plans, 7 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1546$1.8612 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.1964$3.5418 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2021$3.6418 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%25%$0.4209$5.0512 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1237—None
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0941$0.859 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1964$3.5418 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1912—None
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.3048$3.6612 units
  • Quantity limit 12 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 — 9 plans, 7 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 9 of 9 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1666$2.0012 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.3209$3.8512 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$0.00$0.1569$2.8218 units
  • Quantity limit 18 per 30 days
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1596$2.8718 units
  • Quantity limit 18 per 30 days
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4122$4.9512 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1388—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible3Preferred Brand18%18%$0.0954$0.869 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2013—None
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1569$2.8218 units
  • Quantity limit 18 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 — 8 plans, 6 with restrictions
Prior authorization
Step therapy
Quantity limit
Tier
Extra Help (LIS)

Showing 8 of 8 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$8.00$24.00$0.1302—None
Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$4.00$0.00$0.2335$4.2018 units
  • Quantity limit 18 per 30 days
SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand19%19%$0.1079$0.979 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible3Preferred Brand25%25%$0.4265$5.1212 units
  • Quantity limit 12 per 30 days
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1603$1.9212 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2366$4.2618 units
  • Quantity limit 18 per 30 days
Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.2335$4.2018 units
  • Quantity limit 18 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2134—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, 2 with restrictions
Prior authorization
Step therapy
Quantity limit

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible2Generic$5.00$3.00$0.1667$2.0012 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.2794$3.3512 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible2Generic25%25%$0.2277—None

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

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

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic25%25%$0.2848—None

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

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

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic25%25%$0.2359—None

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

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

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$32.10/mo premium · $615.00 deductible2Generic25%25%$0.2848—None

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

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

Showing 1 of 1 plan

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible2Generic25%25%$0.2076—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.