MedicarePartD.guide

A non-government resource built from CMS public data

LORAZEPAM 1 mg Tablet

Package: 1000 TABLET in 1 BOTTLE (69315-905-10). NDC 69315090510.

Plans covering it
367
across 39 regions checked
Lowest tier
1
lower tiers cost less
Plans with restrictions
367
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 122–4$2.0012 of 12 plans
Pennsylvania and West Virginia12 of 122–4$2.0012 of 12 plans
North Carolina12 of 122–4$2.0012 of 12 plans
Alabama and Tennessee12 of 122–4$2.0012 of 12 plans
Michigan12 of 122–4$4.0012 of 12 plans
Illinois12 of 122–4$1.0012 of 12 plans
Arkansas12 of 121–4$0.0012 of 12 plans
Texas12 of 122–4$1.0012 of 12 plans
Kansas12 of 122–4$0.0012 of 12 plans
California12 of 122–4$4.0012 of 12 plans
Connecticut, Massachusetts, Rhode Island and Vermont11 of 112–4$2.0011 of 11 plans
South Carolina11 of 112–4$2.0011 of 11 plans
Oklahoma11 of 112–4$1.0011 of 11 plans
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming11 of 112–4$1.0011 of 11 plans
New Mexico11 of 112–4$4.0011 of 11 plans
New York10 of 102–4$4.0010 of 10 plans
Delaware, DC and Maryland10 of 102–4$2.0010 of 10 plans
Georgia10 of 102–4$2.0010 of 10 plans
Florida10 of 102–4$3.0010 of 10 plans
Ohio10 of 102–4$2.0010 of 10 plans
Indiana and Kentucky10 of 102–4$2.0010 of 10 plans
Wisconsin10 of 102–4$4.0010 of 10 plans
Missouri10 of 102–4$2.0010 of 10 plans
Mississippi10 of 102–4$2.0010 of 10 plans
Louisiana10 of 102–4$2.0010 of 10 plans
Colorado10 of 102–4$2.0010 of 10 plans
Arizona10 of 102–4$4.0010 of 10 plans
Nevada10 of 102–4$2.0010 of 10 plans
Oregon and Washington10 of 102–4$4.0010 of 10 plans
Idaho and Utah10 of 102–4$2.0010 of 10 plans
Maine and New Hampshire9 of 92–4$4.009 of 9 plans
Virginia9 of 92–4$2.009 of 9 plans
Alaska9 of 92–4$4.009 of 9 plans
Hawaii8 of 82–4$4.008 of 8 plans
Puerto Rico3 of 32$2.003 of 3 plans
American Samoa1 of 12—1 of 1 plans
Guam1 of 12—1 of 1 plans
Northern Mariana Islands1 of 12—1 of 1 plans
U.S. Virgin Islands1 of 12—1 of 1 plans

Plan-by-plan detail

Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.

New Jersey — 12 plans, 12 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 Help3Preferred Brand25%20%$0.0972$0.879 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4294$6.4415 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1574$2.3615 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible3Preferred Brand19%14%$0.0978$0.889 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2608$2.359 units
  • Quantity limit 9 per 30 days
Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible2Generic$3.00$4.50$0.2345$2.8112 units
  • Prior authorization
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2145$2.5712 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1671$2.5115 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1049$0.949 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0972$0.879 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.3182$3.8212 units
  • Quantity limit 12 per 30 days
Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible2Generic$6.00$9.00$0.2345$2.8112 units
  • Prior authorization
  • 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.

Pennsylvania and West Virginia — 12 plans, 12 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 Help3Preferred Brand25%20%$0.0848$0.769 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4165$6.2515 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1657$2.4915 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0862$0.789 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1291$1.9415 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2223$2.6712 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2485$2.249 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1047$0.949 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.3135$3.7612 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0848$0.769 units
  • Quantity limit 9 per 30 days
Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible2Generic$5.00$12.50$0.1626$29.27180 units
  • Prior authorization
  • Quantity limit 186 per 31 days
Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible2Generic25%25%$0.1626$29.27180 units
  • Prior authorization
  • Quantity limit 186 per 31 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, 12 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 deductible4Non-Preferred Drug40%40%$0.4134$6.2015 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1692$2.5415 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0911$0.829 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0929$0.849 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2109$2.5312 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3156$2.849 units
  • Quantity limit 9 per 30 days
Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible2Generic$10.00$30.00$0.2769$3.3212 units
  • Prior authorization
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1780$2.6715 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1313$1.189 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0911$0.829 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2900$3.4812 units
  • Quantity limit 12 per 30 days
Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible2Generic$6.00$18.00$0.2769$3.3212 units
  • Prior authorization
  • 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.

Alabama and Tennessee — 12 plans, 12 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 Help3Preferred Brand25%20%$0.0860$0.779 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.3567$5.3515 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1570$2.3515 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0879$0.799 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2125$2.5512 units
  • Quantity limit 12 per 30 days
BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible2Generic$10.00$20.00$0.2432$2.9212 units
  • Prior authorization
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3095$2.799 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1213$1.099 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1695$2.5415 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0860$0.779 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2881$3.4612 units
  • Quantity limit 12 per 30 days
BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible2Generic$12.00$24.00$0.2432$2.9212 units
  • Prior authorization
  • 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.

Michigan — 12 plans, 12 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$0.1531$2.3015 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1083$0.979 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0881$0.799 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help3Preferred Brand20%15%$0.0891$0.809 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.3795$5.6915 units
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2141$2.5712 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2775$2.509 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1724$2.5915 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2956$3.5512 units
  • Quantity limit 12 per 30 days
Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible2Generic$5.00$15.00$0.0431$0.6515 units
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0881$0.799 units
  • Quantity limit 9 per 30 days
Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible2Generic$5.00$10.00$0.0431$0.6515 units
  • Quantity limit 15 per 30 days

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

Illinois — 12 plans, 12 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$0.1853$2.7815 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0969$0.879 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help3Preferred Brand20%15%$0.0983$0.889 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4915$7.3715 units
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.1935$2.3212 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3139$2.839 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible2Generic$5.00$15.00$0.2770$3.3212 units
  • Prior authorization
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1913$2.8715 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2660$3.1912 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1407$1.279 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0969$0.879 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible2Generic$1.00$3.00$0.2699$3.2412 units
  • Prior authorization
  • 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.

Arkansas — 12 plans, 12 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$0.1523$2.2815 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1260$1.139 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0730$0.669 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help3Preferred Brand20%15%$0.0760$0.689 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.2629$3.9415 units
  • Quantity limit 15 per 30 days
BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible2Generic$5.00$15.00$0.0764$1.1515 units
  • Quantity limit 15 per 30 days
HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3404$3.069 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible2Generic$7.00$27.00$0.2189$2.6312 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1547$2.3215 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0730$0.669 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible2Generic$10.00$54.00$0.2948$3.5412 units
  • Quantity limit 12 per 30 days
BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible1Preferred Generic$0.00$0.00$0.0764$1.1515 units
  • Quantity limit 15 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, 12 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$0.1781$2.6715 units
  • Quantity limit 15 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4263$6.3915 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0904$0.819 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible3Preferred Brand25%20%$0.0885$0.809 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2792$2.519 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2033$2.4412 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1983$2.9715 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible2Generic$5.00$15.00$0.2482$2.9812 units
  • Prior authorization
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1204$1.089 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2720$3.2612 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0885$0.809 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible2Generic$1.00$3.00$0.2548$3.0612 units
  • Prior authorization
  • 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.

Kansas — 12 plans, 12 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$0.2673$3.2112 units
  • Prior authorization
  • Quantity limit 12 per 30 days
Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$2.00$6.00$0.2733$3.2812 units
  • Prior authorization
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1352$1.229 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4353$6.5315 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$9.00$27.00$0.1935$2.9015 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0784$0.719 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0807$0.739 units
  • Quantity limit 9 per 30 days
Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible2Generic$0.00$0.00$0.2733$3.2812 units
  • Prior authorization
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1794$2.6915 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2111$2.5312 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0784$0.719 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2890$3.4712 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.

California — 12 plans, 12 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%$0.1067$0.969 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4051$6.0815 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1537$2.3115 units
  • Quantity limit 15 per 30 days
HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2560$2.309 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1740$2.6115 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible3Preferred Brand18%13%$0.0926$0.839 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2175$2.6112 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible3Preferred Brand25%20%$0.0920$0.839 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.3107$3.7312 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0920$0.839 units
  • Quantity limit 9 per 30 days
Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible2Generic$7.00$17.50$0.1259$3.7830 units
  • Quantity limit 1 per 1 days
Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible2Generic$7.00$14.00$0.1259$3.7830 units
  • Quantity limit 1 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, 11 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 Help3Preferred Brand25%20%$0.1022$0.929 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4766$7.1515 units
  • Quantity limit 15 per 30 days
Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$3.00$6.00$0.1441$2.1615 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1690$2.5415 units
  • Quantity limit 15 per 30 days
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1407$2.1115 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2177$2.6112 units
  • Quantity limit 12 per 30 days
Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible3Preferred Brand18%13%$0.1028$0.939 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.1022$0.929 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1086$0.989 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.3111$3.7312 units
  • Quantity limit 12 per 30 days
Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible2Generic$7.00$14.00$0.1441$2.1615 units
  • Quantity limit 15 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, 11 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 deductible4Non-Preferred Drug40%40%$0.4366$6.5515 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1759$2.6415 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0924$0.839 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible3Preferred Brand19%14%$0.0945$0.859 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2964$2.679 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2029$3.0415 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2124$2.5512 units
  • Quantity limit 12 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2939$3.5312 units
  • Quantity limit 12 per 30 days
BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible3Preferred Brand17%17%$0.0502$0.459 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0924$0.839 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1230$1.119 units
  • Quantity limit 9 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, 11 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$0.2826$3.3912 units
  • Prior authorization
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0836$0.759 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.3408$5.1115 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1805$2.7115 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0870$0.789 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3569$3.219 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2101$2.5212 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0836$0.759 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2848$3.4212 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1438$1.299 units
  • Quantity limit 9 per 30 days
Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible2Generic$1.00$3.00$0.3062$3.6712 units
  • Prior authorization
  • 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.

Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming — 11 plans, 11 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 Help3Preferred Brand25%20%$0.0767$0.699 units
  • Quantity limit 9 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$0.2104$2.5212 units
  • Quantity limit 12 per 30 days
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4042$6.0615 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1679$2.5215 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0782$0.709 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1301$1.9515 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2719$2.459 units
  • Quantity limit 9 per 30 days
MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible2Generic$1.00$3.00$0.2673$3.2112 units
  • Prior authorization
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0767$0.699 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1059$0.959 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2807$3.3712 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.

New Mexico — 11 plans, 11 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$0.1893$2.8415 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1570$1.419 units
  • Quantity limit 9 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$0.1941$2.3312 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0919$0.839 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4459$6.6915 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0943$0.859 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0919$0.839 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2688$3.2312 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2044$3.0715 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible2Generic$4.00$12.00$0.2782$3.3412 units
  • Prior authorization
  • Quantity limit 12 per 30 days
Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible2Generic$5.00$15.00$0.2768$3.3212 units
  • Prior authorization
  • 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.

New York — 10 plans, 10 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%$0.0971$0.879 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.3697$5.5515 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1455$2.1815 units
  • Quantity limit 15 per 30 days
HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2441$2.209 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2175$2.6112 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible2Generic$6.00$18.00$0.1525$2.2915 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible3Preferred Brand25%20%$0.0882$0.799 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible3Preferred Brand17%12%$0.0888$0.809 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible2Generic$10.00$0.00$0.3090$3.7112 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0882$0.799 units
  • Quantity limit 9 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, 10 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 Help3Preferred Brand25%20%$0.0917$0.839 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0927$0.839 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4329$6.4915 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1643$2.4615 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1110$1.009 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2093$2.5112 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2606$2.359 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2936$3.5212 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1768$2.6515 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0917$0.839 units
  • Quantity limit 9 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, 10 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$0.1634$2.4515 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0856$0.779 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.3874$5.8115 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0873$0.799 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3051$2.759 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2130$2.5612 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1844$2.7715 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0856$0.779 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2906$3.4912 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1177$1.069 units
  • Quantity limit 9 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, 10 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$0.1715$2.5715 units
  • Quantity limit 15 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4445$6.6715 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible3Preferred Brand20%15%$0.1010$0.919 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible3Preferred Brand25%20%$0.0999$0.909 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2014$3.0215 units
  • Prior authorization
  • Quantity limit 15 per 30 days
BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible2Generic$14.00$42.00$0.2406$2.8912 units
  • Prior authorization
  • Quantity limit 12 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2010$2.4112 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0999$0.909 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2756$3.3112 units
  • Quantity limit 12 per 30 days
BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible2Generic$3.00$9.00$0.2406$2.8912 units
  • Prior authorization
  • 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.

Ohio — 10 plans, 10 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 Help3Preferred Brand25%20%$0.0852$0.779 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4643$6.9615 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1769$2.6515 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0867$0.789 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible2Generic$5.00$3.00$0.2979$2.689 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2120$2.5412 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1984$2.9815 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1226$1.109 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0852$0.779 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2870$3.4412 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.

Indiana and Kentucky — 10 plans, 10 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 Help3Preferred Brand25%20%$0.0877$0.799 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4153$6.2315 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1681$2.5215 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0895$0.819 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1294$1.9415 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3127$2.819 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2162$2.5912 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1259$1.139 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0877$0.799 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2943$3.5312 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.

Wisconsin — 10 plans, 10 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$0.1664$2.5015 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1341$1.219 units
  • Quantity limit 9 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$0.1970$2.3612 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0954$0.869 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help3Preferred Brand20%15%$0.0970$0.879 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4108$6.1615 units
  • Quantity limit 15 per 30 days
SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible2Generic$10.00$30.00$0.1279$1.9215 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3430$3.099 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0954$0.869 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2633$3.1612 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.

Missouri — 10 plans, 10 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 deductible4Non-Preferred Drug40%40%$0.4020$6.0315 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1825$2.7415 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0893$0.809 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0918$0.839 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3170$2.859 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2084$2.5012 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1303$1.179 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1737$2.6115 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2914$3.5012 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0893$0.809 units
  • Quantity limit 9 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, 10 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$0.1463$2.1915 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0792$0.719 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.2963$4.4415 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0815$0.739 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1219$1.109 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3303$2.979 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible2Generic$6.00$18.00$0.2153$2.5812 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0792$0.719 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1575$2.3615 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2936$3.5212 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.

Louisiana — 10 plans, 10 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 Help3Preferred Brand25%20%$0.0907$0.829 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.3486$5.2315 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1581$2.3715 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0928$0.849 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible2Generic$6.00$18.00$0.2074$2.4912 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible2Generic$10.00$30.00$0.1207$1.8115 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1255$1.139 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3190$2.879 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0907$0.829 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2845$3.4112 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.

Colorado — 10 plans, 10 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 Help3Preferred Brand25%20%$0.0817$0.749 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4641$6.9615 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1816$2.7215 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0834$0.759 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1454$1.319 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3558$3.209 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2039$3.0615 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2006$2.4112 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0817$0.749 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2620$3.1412 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.

Arizona — 10 plans, 10 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$0.1915$2.8715 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1487$1.349 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand23%18%$0.0982$0.889 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.5045$7.5715 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0998$0.909 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$0.2200$2.6412 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3286$2.969 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2134$3.2015 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible2Generic$10.00$0.00$0.3023$3.6312 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0982$0.889 units
  • Quantity limit 9 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, 10 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 Help3Preferred Brand25%20%$0.0984$0.899 units
  • Quantity limit 9 per 30 days
Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1910$2.8715 units
  • Quantity limit 15 per 30 days
Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.5062$7.5915 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible3Preferred Brand18%13%$0.1001$0.909 units
  • Quantity limit 9 per 30 days
HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3161$2.849 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible2Generic$6.00$18.00$0.2000$2.4012 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1410$1.279 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2174$3.2615 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2729$3.2712 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0984$0.899 units
  • Quantity limit 9 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, 10 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$0.1744$2.6215 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1344$1.219 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0784$0.719 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4126$6.1915 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0799$0.729 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2097$2.5212 units
  • Quantity limit 12 per 30 days
HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3109$2.809 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1824$2.7415 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0784$0.719 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2783$3.3412 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.

Idaho and Utah — 10 plans, 10 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 Help3Preferred Brand25%20%$0.0742$0.679 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.3275$4.9115 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0760$0.689 units
  • Quantity limit 9 per 30 days
Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1517$2.2815 units
  • Quantity limit 15 per 30 days
SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1174$1.7615 units
  • Prior authorization
  • Quantity limit 15 per 30 days
HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible2Generic$5.00$3.00$0.3330$3.009 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2148$2.5812 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0742$0.679 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1246$1.129 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2848$3.4212 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.

Maine and New Hampshire — 9 plans, 9 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$0.1866$2.8015 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1266$1.149 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0916$0.829 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4532$6.8015 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0936$0.849 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible2Generic$7.00$21.00$0.2024$2.4312 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1936$2.9015 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2699$3.2412 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0916$0.829 units
  • Quantity limit 9 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, 9 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$0.1822$2.7315 units
  • Quantity limit 15 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand25%20%$0.0914$0.829 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible · $0 with full Extra Help3Preferred Brand20%15%$0.0937$0.849 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help4Non-Preferred Drug40%40%$0.4427$6.6415 units
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2110$2.5312 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1955$2.9315 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0914$0.829 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2891$3.4712 units
  • Quantity limit 12 per 30 days
HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1330$1.209 units
  • Quantity limit 9 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, 9 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$0.1991$2.9915 units
  • Quantity limit 15 per 30 days
HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help2Generic10%10%$0.1734$1.569 units
  • Quantity limit 9 per 30 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand24%19%$0.0670$0.609 units
  • Quantity limit 9 per 30 days
Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0676$0.619 units
  • Quantity limit 9 per 30 days
Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.3899$5.8515 units
  • Quantity limit 15 per 30 days
AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible2Generic$8.00$24.00$0.2381$2.8612 units
  • Quantity limit 12 per 30 days
SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible2Generic$7.00$21.00$0.1952$2.9315 units
  • Prior authorization
  • Quantity limit 15 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.2974$3.5712 units
  • Quantity limit 12 per 30 days
Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0670$0.609 units
  • Quantity limit 9 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, 8 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$0.2261$2.7112 units
  • Quantity limit 12 per 30 days
Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible · $0 with full Extra Help3Preferred Brand23%18%$0.0956$0.869 units
  • Quantity limit 9 per 30 days
SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1414$2.1215 units
  • Prior authorization
  • Quantity limit 15 per 30 days
Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible4Non-Preferred Drug40%40%$0.4498$6.7515 units
  • Quantity limit 15 per 30 days
Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible · $0 with full Extra Help2Generic$10.00$30.00$0.1757$2.6415 units
  • Quantity limit 15 per 30 days
Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible3Preferred Brand20%15%$0.0964$0.879 units
  • Quantity limit 9 per 30 days
Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible2Generic$4.00$0.00$0.0956$0.869 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible2Generic$10.00$0.00$0.3324$3.9912 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.

Puerto Rico — 3 plans, 3 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$0.3247$2.929 units
  • Quantity limit 9 per 30 days
HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible2Generic$2.00$2.00$0.1060$0.959 units
  • Quantity limit 9 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible2Generic25%25%$0.3215$3.8612 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.

American Samoa — 1 plan, 1 with restrictions
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%$0.3291$3.9512 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.

Guam — 1 plan, 1 with restrictions
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%$0.3393$4.0712 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.

Northern Mariana Islands — 1 plan, 1 with restrictions
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%$0.3393$4.0712 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.

U.S. Virgin Islands — 1 plan, 1 with restrictions
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%$0.3302$3.9612 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.