MedicarePartD.guide

A non-government resource built from CMS public data

LITHIUM CARBONATE 150 mg Capsule

Package: 100 CAPSULE in 1 BOTTLE (68462-220-01). NDC 68462022001.

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

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 121–2$0.00none
Pennsylvania and West Virginia12 of 121–2$0.00none
North Carolina12 of 121–2$0.00none
Alabama and Tennessee12 of 121–2$0.00none
Michigan12 of 121–2$0.00none
Illinois12 of 121–2$0.00none
Arkansas12 of 121–2$0.00none
Texas12 of 121–2$0.00none
Kansas12 of 121–2$0.00none
California12 of 121–2$0.00none
Connecticut, Massachusetts, Rhode Island and Vermont11 of 111–2$0.00none
South Carolina11 of 111–2$0.00none
Oklahoma11 of 111–2$0.00none
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming11 of 111–2$0.00none
New Mexico11 of 111–2$0.00none
New York10 of 101–2$0.00none
Delaware, DC and Maryland10 of 101–2$0.00none
Georgia10 of 101–2$0.00none
Florida10 of 101–2$0.00none
Ohio10 of 101–2$0.00none
Indiana and Kentucky10 of 101–2$0.00none
Wisconsin10 of 101–2$0.00none
Missouri10 of 101–2$0.00none
Mississippi10 of 101–2$0.00none
Louisiana10 of 101–2$0.00none
Colorado10 of 101–2$0.00none
Arizona10 of 101–2$0.00none
Nevada10 of 101–2$0.00none
Oregon and Washington10 of 101–2$0.00none
Idaho and Utah10 of 101–2$0.00none
Maine and New Hampshire9 of 91–2$0.00none
Virginia9 of 91–2$0.00none
Alaska9 of 91–2$0.00none
Hawaii8 of 81–2$0.00none
Puerto Rico3 of 31–2$0.00none
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
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$0.2693—None
Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0411—None
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1120—None
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2716—None
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0894—None
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible2Generic$3.00$4.50$0.1183—None
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1139—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0920—None
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1112—None
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2693—None
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1145—None
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible1Preferred Generic$0.00$0.00$0.1183—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
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$0.2467—None
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0531—None
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1102—None
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2503—None
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$2.00$6.00$0.0795—None
AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1128—None
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0874—None
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1090—None
AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1137—None
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2467—None
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible1Preferred Generic$0.00$0.00$0.0834—None
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible1Preferred Generic25%25%$0.0832—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
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 deductible1Preferred Generic$0.00$0.00$0.0517—None
Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1188—None
Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2615—None
Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2682—None
AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1124—None
HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1004—None
Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible2Generic$10.00$30.00$0.1242—None
SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0836—None
HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1173—None
Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2615—None
AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—None
Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible1Preferred Generic$3.00$9.00$0.1242—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
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$0.2563—None
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0526—None
Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1123—None
Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2620—None
AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1124—None
BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible2Generic$10.00$20.00$0.1050—None
HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0955—None
HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1099—None
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0962—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2563—None
AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—None
BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible2Generic$12.00$24.00$0.1050—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0519—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1057—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1037—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2439—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2471—None
AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1124—None
HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0920—None
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0994—None
AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—None
Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible2Generic$5.00$15.00$0.0987—None
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2439—None
Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible2Generic$5.00$10.00$0.0987—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0391—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1179—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2551—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2584—None
AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1130—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0924—None
Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible2Generic$5.00$15.00$0.1388—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0959—None
AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1138—None
HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1156—None
Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2551—None
Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1465—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0747—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1053—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1027—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2240—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2350—None
BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible2Generic$5.00$15.00$0.0848—None
HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0974—None
AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible2Generic$7.00$27.00$0.1124—None
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1080—None
Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2240—None
AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible2Generic$10.00$54.00$0.1135—None
BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.0848—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0499—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1109—None
Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2594—None
Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible2Generic$1.00$0.00$0.2535—None
HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0937—None
AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1125—None
SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0926—None
Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible2Generic$5.00$15.00$0.1346—None
HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1102—None
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1135—None
Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2535—None
Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1441—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
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$0.1500—None
Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$6.00$0.1506—None
HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1093—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0607—None
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$9.00$27.00$0.1142—None
Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2287—None
Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2359—None
Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.1506—None
SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1051—None
AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1134—None
Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2287—None
AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1142—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
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%$0.1119—None
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0426—None
Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1133—None
HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0883—None
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0784—None
Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2670—None
AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1131—None
Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible2Generic$1.00$0.00$0.2642—None
AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1139—None
Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2642—None
Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible2Generic$7.00$17.50$0.2750—None
Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible2Generic$7.00$14.00$0.2750—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
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$0.2774—None
Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0364—None
Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$6.00$0.0946—None
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1171—None
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$2.00$6.00$0.0646—None
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1129—None
Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2791—None
Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2774—None
HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1160—None
AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1137—None
Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible1Preferred Generic$1.00$1.00$0.0946—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
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 deductible1Preferred Generic$0.00$0.00$0.0450—None
Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1150—None
Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$0.00$0.2717—None
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2769—None
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0934—None
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0786—None
AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1124—None
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—None
BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible2Generic$17.00$42.50$0.1083—None
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2717—None
HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1129—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
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$0.1252—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$0.00$0.2339—None
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0783—None
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1077—None
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2443—None
HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0981—None
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1125—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2339—None
AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1136—None
HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1051—None
Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1357—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
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$0.2266—None
AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$7.00$21.00$0.1130—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0690—None
Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1119—None
Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2321—None
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$2.00$6.00$0.0776—None
HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0928—None
MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible2Generic$1.00$3.00$0.1454—None
Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2266—None
HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1018—None
AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1140—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0605—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1197—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1188—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2598—None
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$6.00$18.00$0.1127—None
Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2681—None
Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2598—None
AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1136—None
SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0973—None
Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible2Generic$4.00$12.00$0.1489—None
Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible2Generic$5.00$15.00$0.1389—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
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%$0.1028—None
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0515—None
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1061—None
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0849—None
AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1129—None
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0900—None
Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible2Generic$1.00$0.00$0.2438—None
Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2453—None
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1139—None
Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2438—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
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$0.2574—None
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2597—None
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0426—None
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1088—None
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1068—None
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1129—None
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0865—None
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1137—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0894—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2574—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0506—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1123—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2522—None
Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2566—None
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0983—None
AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1125—None
SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0883—None
Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2522—None
AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1135—None
HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1116—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0463—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1094—None
Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2764—None
Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible2Generic$1.00$0.00$0.2733—None
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0904—None
BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible2Generic$14.00$42.00$0.1308—None
AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1131—None
Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2733—None
AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1139—None
BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible2Generic$3.00$9.00$0.1308—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
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$0.2443—None
Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0456—None
Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1138—None
Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2483—None
HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0933—None
AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1125—None
SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0917—None
HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1125—None
Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2443—None
AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1135—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
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$0.2507—None
Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0523—None
Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1150—None
Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2559—None
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$2.00$6.00$0.0721—None
HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0964—None
AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1123—None
HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1143—None
Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2507—None
AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1132—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0552—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1130—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1106—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2553—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2624—None
AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$7.00$21.00$0.1124—None
SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0785—None
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0976—None
Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2553—None
AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—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
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 deductible1Preferred Generic$0.00$0.00$0.0593—None
Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1124—None
Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2493—None
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2563—None
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0938—None
AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1129—None
HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1079—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0973—None
AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1138—None
Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2493—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0778—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1061—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2249—None
Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2370—None
HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1027—None
HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0975—None
AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible2Generic$6.00$18.00$0.1124—None
Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2249—None
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1074—None
AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—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
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$0.2619—None
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0572—None
Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1095—None
Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2684—None
AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible2Generic$6.00$18.00$0.1124—None
SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible1Preferred Generic$2.00$6.00$0.0780—None
HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1080—None
HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0930—None
Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2619—None
AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0491—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2204—None
Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1124—None
Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2257—None
HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1113—None
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0979—None
SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1038—None
AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1125—None
Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2204—None
AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0449—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1221—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1216—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$0.00$0.2565—None
Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2598—None
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1124—None
HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0997—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0877—None
AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—None
Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2565—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
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$0.2575—None
Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0375—None
Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1189—None
Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2618—None
HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0986—None
AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible2Generic$6.00$18.00$0.1124—None
HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1184—None
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0880—None
AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1133—None
Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2575—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
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)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0498—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1101—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1086—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2310—None
Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2347—None
AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1125—None
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0901—None
SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0990—None
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2310—None
AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1134—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
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$0.2317—None
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0544—None
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2365—None
Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1068—None
SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$2.00$6.00$0.0757—None
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0944—None
AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1128—None
Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2317—None
HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1058—None
AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1138—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
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 Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0596—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1078—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1076—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2481—None
Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2524—None
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1123—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0919—None
AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1132—None
Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2481—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
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 Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$0.00$0.00$0.0522—None
Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1168—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$1.00$0.00$0.2645—None
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help2Generic$0.00$0.00$0.2717—None
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1124—None
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0826—None
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2645—None
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1133—None
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1166—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
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$0.0961—None
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.0950—None
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$0.00$0.1929—None
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.1973—None
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0681—None
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1123—None
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.1137—None
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1132—None
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.1929—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
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$0.1124—None
Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$4.00$0.00$0.2857—None
SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help1Preferred Generic$2.00$6.00$0.0588—None
Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0244—None
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1216—None
Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible2Generic$0.00$0.00$0.2860—None
Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.2857—None
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.1133—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
Prior authorization
Step therapy
Quantity limit
Tier

Showing 3 of 3 plans

PlanTier30-day preferred90-day mailUnit costEst. 30-day fillRestrictions
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible1Preferred Generic$0.00$0.00$0.0919—None
HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1130—None
AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible2Generic25%25%$0.1136—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%$0.1202—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%$0.1202—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%$0.1202—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%$0.1202—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.