NALOXONE HYDROCHLORIDE .4 mg/mL Injection, Solution
Package: 10 VIAL in 1 CARTON (70069-071-10) / 1 mL in 1 VIAL (70069-071-01). NDC 70069007110.
- Plans covering it
- 367
- across 39 regions checked
- Lowest tier
- 1
- lower tiers cost less
- Plans with restrictions
- 0
- prior auth, step therapy or quantity limit
Coverage by region
Covered by at least one plan in 39 of 39 CMS regions.
| Region | Plans covering | Tiers | Lowest 30-day cost | Restrictions |
|---|---|---|---|---|
| New Jersey | 12 of 12 | 1–2 | $0.00 | none |
| Pennsylvania and West Virginia | 12 of 12 | 1–2 | $0.00 | none |
| North Carolina | 12 of 12 | 1–2 | $0.00 | none |
| Alabama and Tennessee | 12 of 12 | 1–2 | $0.00 | none |
| Michigan | 12 of 12 | 1–2 | $0.00 | none |
| Illinois | 12 of 12 | 1–2 | $0.00 | none |
| Arkansas | 12 of 12 | 1–2 | $0.00 | none |
| Texas | 12 of 12 | 1–2 | $0.00 | none |
| Kansas | 12 of 12 | 1–2 | $0.00 | none |
| California | 12 of 12 | 1–2 | $0.00 | none |
| Connecticut, Massachusetts, Rhode Island and Vermont | 11 of 11 | 1–2 | $0.00 | none |
| South Carolina | 11 of 11 | 1–2 | $0.00 | none |
| Oklahoma | 11 of 11 | 1–2 | $0.00 | none |
| Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming | 11 of 11 | 1–2 | $0.00 | none |
| New Mexico | 11 of 11 | 1–2 | $0.00 | none |
| New York | 10 of 10 | 1–2 | $0.00 | none |
| Delaware, DC and Maryland | 10 of 10 | 1–2 | $0.00 | none |
| Georgia | 10 of 10 | 1–2 | $0.00 | none |
| Florida | 10 of 10 | 1–2 | $0.00 | none |
| Ohio | 10 of 10 | 1–2 | $0.00 | none |
| Indiana and Kentucky | 10 of 10 | 1–2 | $0.00 | none |
| Wisconsin | 10 of 10 | 1–2 | $0.00 | none |
| Missouri | 10 of 10 | 1–2 | $0.00 | none |
| Mississippi | 10 of 10 | 1–2 | $0.00 | none |
| Louisiana | 10 of 10 | 1–2 | $0.00 | none |
| Colorado | 10 of 10 | 1–2 | $0.00 | none |
| Arizona | 10 of 10 | 1–2 | $0.00 | none |
| Nevada | 10 of 10 | 1–2 | $0.00 | none |
| Oregon and Washington | 10 of 10 | 1–2 | $0.00 | none |
| Idaho and Utah | 10 of 10 | 1–2 | $0.00 | none |
| Maine and New Hampshire | 9 of 9 | 1–2 | $0.00 | none |
| Virginia | 9 of 9 | 1–2 | $0.00 | none |
| Alaska | 9 of 9 | 1–2 | $0.00 | none |
| Hawaii | 8 of 8 | 1–2 | $0.00 | none |
| Puerto Rico | 3 of 3 | 2 | $2.00 | none |
| American Samoa | 1 of 1 | 2 | — | none |
| Guam | 1 of 1 | 2 | — | none |
| Northern Mariana Islands | 1 of 1 | 2 | — | none |
| U.S. Virgin Islands | 1 of 1 | 2 | — | none |
Plan-by-plan detail
Open a region to see every plan that covers this drug, with tier, cost-sharing and restrictions.
New Jersey — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.4224 | — | None |
| Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.4224 | — | None |
| Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.4224 | — | None |
| Wellcare Value Script (PDP)$22.80/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $3.3145 | — | None |
| Wellcare Classic (PDP)$28.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $3.4035 | — | None |
| HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $3.6285 | — | None |
| Horizon Medicare Blue Rx Standard (PDP)$72.30/mo premium · $615.00 deductible | 2Generic | $3.00 | $4.50 | $13.5965 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$77.40/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $7.8952 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.2607 | — | None |
| HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $6.4867 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.0694 | — | None |
| Horizon Medicare Blue Rx Enhanced (PDP)$139.10/mo premium · $200.00 deductible | 2Generic | $6.00 | $9.00 | $13.5965 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Pennsylvania and West Virginia — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.60/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $8.1591 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $8.1591 | — | None |
| Humana Premier Rx Plan (PDP)$123.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $8.1591 | — | None |
| Wellcare Value Script (PDP)$8.20/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $5.1402 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $5.1592 | — | None |
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $7.0913 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$43.50/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.1125 | — | None |
| HealthSpring Extra Rx (PDP)$62.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $3.6475 | — | None |
| HealthSpring Assurance Rx (PDP)$74.00/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $8.4918 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.6914 | — | None |
| Blue Rx PDP Complete (PDP)$164.80/mo premium · $200.00 deductible | 2Generic | $5.00 | $12.50 | $6.5189 | — | None |
| Blue Rx PDP Plus (PDP)$193.20/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $6.5278 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
North Carolina — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$6.80/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.9094 | — | None |
| Humana Value Rx Plan (PDP)$32.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.2111 | — | None |
| Humana Premier Rx Plan (PDP)$110.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.9094 | — | None |
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.2377 | — | None |
| Wellcare Classic (PDP)$4.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.3761 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.90/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $4.6381 | — | None |
| HealthSpring Extra Rx (PDP)$78.00/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.2003 | — | None |
| Blue Medicare Rx Standard (PDP)$83.90/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $11.3365 | — | None |
| SilverScript Choice (PDP)$90.20/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.8241 | — | None |
| HealthSpring Assurance Rx (PDP)$110.40/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $8.4096 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.9715 | — | None |
| Blue Medicare Rx Enhanced (PDP)$163.20/mo premium · $0.00 deductible | 2Generic | $6.00 | $18.00 | $11.3365 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Alabama and Tennessee — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.5826 | — | None |
| Humana Value Rx Plan (PDP)$37.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.7631 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.5826 | — | None |
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $3.7967 | — | None |
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $3.8676 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$63.20/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $5.6446 | — | None |
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $20.00 | $11.5375 | — | None |
| HealthSpring Extra Rx (PDP)$77.50/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.2415 | — | None |
| HealthSpring Assurance Rx (PDP)$87.20/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $6.8355 | — | None |
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.3186 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.3951 | — | None |
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 2Generic | $12.00 | $24.00 | $11.5375 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Michigan — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $11.4651 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $11.4867 | — | None |
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $11.4651 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.8487 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.7328 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $7.0225 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $5.4039 | — | None |
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $4.6338 | — | None |
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.7594 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.7111 | — | None |
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $6.2589 | — | None |
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 2Generic | $5.00 | $10.00 | $6.2589 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Illinois — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.0573 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.0650 | — | None |
| Humana Premier Rx Plan (PDP)$119.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.0573 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3782 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $0.1488 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$40.20/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $3.3357 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.5748 | — | None |
| Blue Cross MedicareRx Basic (PDP)$89.70/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $12.4931 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.9759 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$103.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $6.6735 | — | None |
| HealthSpring Assurance Rx (PDP)$104.20/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.6142 | — | None |
| Blue Cross MedicareRx Value (PDP)$119.70/mo premium · $615.00 deductible | 2Generic | $1.00 | $3.00 | $11.5874 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Arkansas — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.2639 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.4806 | — | None |
| Humana Premier Rx Plan (PDP)$92.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.2639 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.0538 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.9031 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $8.3679 | — | None |
| BlueMedicare Value Rx (PDP)$52.50/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $5.6250 | — | None |
| HealthSpring Extra Rx (PDP)$54.50/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.5710 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$65.10/mo premium · $615.00 deductible | 2Generic | $7.00 | $27.00 | $4.5311 | — | None |
| SilverScript Choice (PDP)$73.50/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.2694 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $54.00 | $7.6444 | — | None |
| BlueMedicare Premier Rx (PDP)$181.20/mo premium · $0.00 deductible | 2Generic | $5.00 | $15.00 | $5.6250 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Texas — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$22.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.8193 | — | None |
| Humana Basic Rx Plan (PDP)$41.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.4128 | — | None |
| Humana Premier Rx Plan (PDP)$118.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.4128 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $3.6109 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $3.5080 | — | None |
| HealthSpring Extra Rx (PDP)$70.00/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.5538 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$89.20/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.7569 | — | None |
| SilverScript Choice (PDP)$94.80/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.3094 | — | None |
| Blue Cross MedicareRx Basic (PDP)$104.70/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $11.3815 | — | None |
| HealthSpring Assurance Rx (PDP)$111.40/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $7.6112 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.9226 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.40/mo premium · $615.00 deductible | 2Generic | $1.00 | $3.00 | $12.2446 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Kansas — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$15.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.1499 | — | None |
| Humana Value Rx Plan (PDP)$55.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.1555 | — | None |
| Humana Premier Rx Plan (PDP)$116.30/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.1499 | — | None |
| Blue MedicareRx Essentials (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $0.00 | $0.00 | $5.5157 | — | None |
| Blue MedicareRx Value (PDP)$0.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $6.00 | $5.5157 | — | None |
| HealthSpring Assurance Rx (PDP)$6.70/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $9.6311 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $0.1246 | — | None |
| Wellcare Classic (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $9.00 | $27.00 | $0.3540 | — | None |
| Blue MedicareRx Plus (PDP)$67.40/mo premium · $0.00 deductible | 2Generic | $0.00 | $0.00 | $5.5157 | — | None |
| SilverScript Choice (PDP)$88.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $7.0384 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $3.3930 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$147.00/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $6.6706 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
California — 12 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$104.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.1537 | — | None |
| Humana Basic Rx Plan (PDP)$132.20/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.0967 | — | None |
| Humana Premier Rx Plan (PDP)$172.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.0967 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $6.4200 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $3.9471 | — | None |
| Wellcare Classic (PDP)$6.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $4.0347 | — | None |
| HealthSpring Extra Rx (PDP)$70.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $4.3913 | — | None |
| SilverScript Choice (PDP)$103.60/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.3659 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$109.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.6961 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$165.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.9449 | — | None |
| Blue Shield Rx Plus (PDP)$199.70/mo premium · $615.00 deductible | 2Generic | $7.00 | $17.50 | $6.1198 | — | None |
| Blue Shield Rx Enhanced (PDP)$227.80/mo premium · $0.00 deductible | 2Generic | $7.00 | $14.00 | $6.1198 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Connecticut, Massachusetts, Rhode Island and Vermont — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $14.0016 | — | None |
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $14.0016 | — | None |
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $14.0016 | — | None |
| Wellcare Value Script (PDP)$16.40/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.0686 | — | None |
| Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $6.00 | $5.6250 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.2571 | — | None |
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $7.8312 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $4.9449 | — | None |
| HealthSpring Assurance Rx (PDP)$139.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.2250 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.5806 | — | None |
| Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible | 2Generic | $7.00 | $14.00 | $5.6250 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
South Carolina — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$10.10/mo premium · $615.00 deductible | 1Preferred Generic | $1.00 | $0.00 | $12.2319 | — | None |
| Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.2319 | — | None |
| Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.2319 | — | None |
| Wellcare Value Script (PDP)$4.80/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.3087 | — | None |
| Wellcare Classic (PDP)$9.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.4435 | — | None |
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $3.4385 | — | None |
| SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.1625 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$122.10/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.4563 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.5816 | — | None |
| BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible | 2Generic | $17.00 | $42.50 | $6.4402 | — | None |
| HealthSpring Assurance Rx (PDP)$152.50/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $7.6145 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oklahoma — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $1.00 | $0.00 | $8.5176 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $8.8398 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $8.5176 | — | None |
| Blue Cross MedicareRx Basic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $14.4751 | — | None |
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $5.6950 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $5.7005 | — | None |
| HealthSpring Extra Rx (PDP)$65.40/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $9.1440 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.9476 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$121.00/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $9.0258 | — | None |
| HealthSpring Assurance Rx (PDP)$126.50/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.3002 | — | None |
| Blue Cross MedicareRx Value (PDP)$167.30/mo premium · $615.00 deductible | 2Generic | $1.00 | $3.00 | $14.7110 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$4.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.0283 | — | None |
| Humana Value Rx Plan (PDP)$20.80/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.2630 | — | None |
| Humana Premier Rx Plan (PDP)$103.70/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.0283 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$5.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $4.8966 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.9425 | — | None |
| Wellcare Classic (PDP)$12.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $3.0805 | — | None |
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $6.7377 | — | None |
| HealthSpring Extra Rx (PDP)$66.50/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.8026 | — | None |
| MedicareBlue Rx Standard (PDP)$101.00/mo premium · $615.00 deductible | 2Generic | $1.00 | $3.00 | $11.3787 | — | None |
| HealthSpring Assurance Rx (PDP)$125.90/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $8.1665 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.7107 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
New Mexico — 11 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.9345 | — | None |
| Humana Value Rx Plan (PDP)$69.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.9345 | — | None |
| Humana Premier Rx Plan (PDP)$75.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.9345 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.9750 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.4867 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $7.7483 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $6.00 | $18.00 | $5.3002 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$82.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.0284 | — | None |
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.5808 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 2Generic | $4.00 | $12.00 | $13.4104 | — | None |
| Blue Cross MedicareRx Basic (PDP)$145.40/mo premium · $615.00 deductible | 2Generic | $5.00 | $15.00 | $14.1731 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
New York — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$140.90/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.6694 | — | None |
| Humana Value Rx Plan (PDP)$158.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.6776 | — | None |
| Humana Premier Rx Plan (PDP)$173.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.6694 | — | None |
| HealthSpring Assurance Rx (PDP)$35.70/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $5.1174 | — | None |
| Wellcare Value Script (PDP)$42.40/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $4.6132 | — | None |
| Wellcare Classic (PDP)$45.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $4.6484 | — | None |
| HealthSpring Extra Rx (PDP)$91.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $3.9248 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$105.80/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $6.1137 | — | None |
| SilverScript Choice (PDP)$116.00/mo premium · $615.00 deductible | 2Generic | $6.00 | $18.00 | $8.6542 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$163.70/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.8567 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Delaware, DC and Maryland — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.6267 | — | None |
| Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.8531 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.6267 | — | None |
| Wellcare Value Script (PDP)$5.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.2030 | — | None |
| Wellcare Classic (PDP)$5.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.3864 | — | None |
| HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.4626 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.80/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $5.0475 | — | None |
| HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $3.8068 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$94.50/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.6226 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.5935 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Georgia — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.0126 | — | None |
| Humana Value Rx Plan (PDP)$36.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.2195 | — | None |
| Humana Premier Rx Plan (PDP)$129.50/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.0126 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $3.2314 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $3.1316 | — | None |
| HealthSpring Extra Rx (PDP)$71.20/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $4.7769 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.00/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $5.4420 | — | None |
| SilverScript Choice (PDP)$100.70/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.8361 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.6180 | — | None |
| HealthSpring Assurance Rx (PDP)$149.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $7.5242 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Florida — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Value Rx Plan (PDP)$25.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.0451 | — | None |
| Humana Basic Rx Plan (PDP)$92.70/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.0129 | — | None |
| Humana Premier Rx Plan (PDP)$115.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.0129 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.2136 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.0667 | — | None |
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.5410 | — | None |
| BlueMedicare Premier Rx (PDP)$98.60/mo premium · $615.00 deductible | 2Generic | $14.00 | $42.00 | $12.8455 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$98.70/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $7.2610 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$119.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.3107 | — | None |
| BlueMedicare Complete Rx (PDP)$217.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $12.8455 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Ohio — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.9651 | — | None |
| Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.2873 | — | None |
| Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.9651 | — | None |
| Wellcare Value Script (PDP)$7.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.4292 | — | None |
| Wellcare Classic (PDP)$7.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.5602 | — | None |
| HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.5770 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$73.70/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $5.0207 | — | None |
| SilverScript Choice (PDP)$90.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.9517 | — | None |
| HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $8.8635 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$123.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.1206 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Indiana and Kentucky — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $11.3313 | — | None |
| Humana Value Rx Plan (PDP)$9.90/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $11.4427 | — | None |
| Humana Premier Rx Plan (PDP)$125.30/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $11.3313 | — | None |
| Wellcare Value Script (PDP)$8.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.7216 | — | None |
| Wellcare Classic (PDP)$8.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.8840 | — | None |
| SilverScript Choice (PDP)$29.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $6.3184 | — | None |
| HealthSpring Extra Rx (PDP)$78.20/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.6326 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$90.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.4006 | — | None |
| HealthSpring Assurance Rx (PDP)$117.80/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.0128 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$127.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.3041 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Wisconsin — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $14.1840 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $14.4632 | — | None |
| Humana Premier Rx Plan (PDP)$110.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $14.1840 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.0460 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.8927 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $8.6027 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $3.6428 | — | None |
| SilverScript Choice (PDP)$26.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $7.4015 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.8460 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$113.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.0450 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Missouri — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$16.50/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.8486 | — | None |
| Humana Value Rx Plan (PDP)$33.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $11.3844 | — | None |
| Humana Premier Rx Plan (PDP)$126.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.8486 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $4.8245 | — | None |
| Wellcare Classic (PDP)$10.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $4.8562 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $8.5362 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$71.90/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $5.1143 | — | None |
| HealthSpring Assurance Rx (PDP)$74.30/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.3566 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.4150 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$125.40/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.0222 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Mississippi — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.1360 | — | None |
| Humana Value Rx Plan (PDP)$37.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.8341 | — | None |
| Humana Premier Rx Plan (PDP)$89.90/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.1360 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.7498 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.6263 | — | None |
| HealthSpring Assurance Rx (PDP)$59.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.0868 | — | None |
| HealthSpring Extra Rx (PDP)$77.10/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $6.8856 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$84.70/mo premium · $615.00 deductible | 2Generic | $6.00 | $18.00 | $4.0151 | — | None |
| SilverScript Choice (PDP)$98.30/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $5.4653 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$140.60/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.4657 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Louisiana — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.3743 | — | None |
| Humana Value Rx Plan (PDP)$19.30/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.3743 | — | None |
| Humana Premier Rx Plan (PDP)$113.70/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.3743 | — | None |
| Wellcare Value Script (PDP)$5.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.1184 | — | None |
| Wellcare Classic (PDP)$6.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.2604 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$37.00/mo premium · $615.00 deductible | 2Generic | $6.00 | $18.00 | $5.2592 | — | None |
| SilverScript Choice (PDP)$44.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $7.3445 | — | None |
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $7.9324 | — | None |
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $3.5794 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.50/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.5622 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Colorado — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.4908 | — | None |
| Humana Value Rx Plan (PDP)$48.50/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.8259 | — | None |
| Humana Premier Rx Plan (PDP)$137.10/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.4908 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $1.8660 | — | None |
| Wellcare Classic (PDP)$2.20/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.2372 | — | None |
| HealthSpring Assurance Rx (PDP)$61.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $9.1408 | — | None |
| HealthSpring Extra Rx (PDP)$70.70/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.8220 | — | None |
| SilverScript Choice (PDP)$105.10/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $7.5411 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$125.00/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $6.3451 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$151.90/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.7894 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Arizona — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $0.00 | $12.6060 | — | None |
| Humana Value Rx Plan (PDP)$2.50/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.0087 | — | None |
| Humana Premier Rx Plan (PDP)$119.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $12.6060 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.5146 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.2329 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $8.9794 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.70/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $4.7718 | — | None |
| HealthSpring Extra Rx (PDP)$66.40/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.6640 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $7.1773 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$97.50/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.4471 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Nevada — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.7538 | — | None |
| Humana Value Rx Plan (PDP)$43.70/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.7538 | — | None |
| Humana Premier Rx Plan (PDP)$148.70/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $13.7538 | — | None |
| Wellcare Classic (PDP)$2.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.7397 | — | None |
| Wellcare Value Script (PDP)$2.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $0.4700 | — | None |
| HealthSpring Extra Rx (PDP)$52.60/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $4.7994 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$76.70/mo premium · $615.00 deductible | 2Generic | $6.00 | $18.00 | $4.6164 | — | None |
| HealthSpring Assurance Rx (PDP)$95.60/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $8.3606 | — | None |
| SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.8133 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.10/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.6324 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Oregon and Washington — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.0069 | — | None |
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.2925 | — | None |
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.0069 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $3.5687 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $3.1445 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $7.9253 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $6.0721 | — | None |
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $4.9995 | — | None |
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $7.0342 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.3178 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Idaho and Utah — 10 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.8835 | — | None |
| Humana Value Rx Plan (PDP)$19.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $10.2377 | — | None |
| Humana Premier Rx Plan (PDP)$115.50/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $9.8835 | — | None |
| Wellcare Value Script (PDP)$9.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $3.5779 | — | None |
| Wellcare Classic (PDP)$23.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $3.6614 | — | None |
| SilverScript Choice (PDP)$27.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $6.2448 | — | None |
| HealthSpring Extra Rx (PDP)$56.30/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $5.5086 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$56.50/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $5.9163 | — | None |
| HealthSpring Assurance Rx (PDP)$128.60/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $7.0884 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$132.60/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $8.3102 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Maine and New Hampshire — 9 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $7.5180 | — | None |
| Humana Value Rx Plan (PDP)$54.40/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $7.5180 | — | None |
| Humana Premier Rx Plan (PDP)$150.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $7.5180 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $5.7850 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $5.2250 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $8.8250 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$82.40/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.1112 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $6.2668 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $6.8845 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Virginia — 9 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $15.3321 | — | None |
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $15.5585 | — | None |
| Humana Premier Rx Plan (PDP)$87.60/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $15.3321 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $2.2961 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $2.1473 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$39.60/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $4.7970 | — | None |
| SilverScript Choice (PDP)$78.20/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $7.0216 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.80/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $7.7753 | — | None |
| HealthSpring Assurance Rx (PDP)$133.80/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $10.1247 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Alaska — 9 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 1Preferred Generic | $2.00 | $0.00 | $17.1840 | — | None |
| Humana Value Rx Plan (PDP)$10.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.1840 | — | None |
| Humana Premier Rx Plan (PDP)$112.40/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $17.1840 | — | None |
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $0.3400 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 10% | 10% | $9.6300 | — | None |
| Wellcare Value Script (PDP)$19.70/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $0.1100 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$53.20/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $3.3093 | — | None |
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 2Generic | $7.00 | $21.00 | $7.1168 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$100.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $6.6682 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Hawaii — 8 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.40/mo premium · $615.00 deductible | 1Preferred Generic | $3.00 | $0.00 | $8.1792 | — | None |
| Humana Value Rx Plan (PDP)$51.60/mo premium · $601.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $8.2228 | — | None |
| Humana Premier Rx Plan (PDP)$90.20/mo premium · $0.00 deductible | 1Preferred Generic | $0.00 | $0.00 | $8.1792 | — | None |
| AARP Medicare Rx Saver from UHC (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | $8.00 | $24.00 | $6.1112 | — | None |
| SilverScript Choice (PDP)$14.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $9.3750 | — | None |
| Wellcare Value Script (PDP)$21.60/mo premium · $615.00 deductible | 2Generic | $3.00 | $9.00 | $5.9600 | — | None |
| Wellcare Classic (PDP)$21.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $5.9600 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 2Generic | $10.00 | $0.00 | $9.1451 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Puerto Rico — 3 plans
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 2Generic | $5.00 | $3.00 | $4.9031 | — | None |
| HealthSpring Assurance Rx (PDP)$65.70/mo premium · $615.00 deductible | 2Generic | $2.00 | $2.00 | $7.4098 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$145.10/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $9.0505 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
American Samoa — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $8.8186 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Guam — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $8.8186 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
Northern Mariana Islands — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$32.10/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $8.8186 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity — elsewhere it depends on what is prescribed.
U.S. Virgin Islands — 1 plan
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible | 2Generic | 25% | 25% | $8.8186 | — | 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.