There are 40 stand-alone Medicare Part D plans in Utah meeting your criteria.
Caution: The 2009 Medicare Part D plan information below is for research purposes.
Click here to see 2024 Medicare Part D plans
CYCLOSPORINE 50MG CAPSULE (NDC: 00172731100) 2009 Medicare Prescription Drug Plan (PDP) Information Click here for the Chart Legend | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information | Cost-Sharing | Drug Usage Mgmt |
|||
---|---|---|---|---|---|---|---|---|---|
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Order |
||||||
First Health Part D-Secure |
$18.50 | $175 | No Gap Coverage | 1 | Preferred Generic | $4.00 | n/a | P | |
Browse Plan Formulary | |||||||||
AdvantraRx Value |
$27.20 | $0 | No Gap Coverage | 1 | Preferred Generic | $8.00 | $16.00 | P | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Value |
$31.90 | $295 | No Gap Coverage | 2 | Preferred Brand | 23% | 23% | P | |
Browse Plan Formulary | |||||||||
SilverScript Value |
$32.20 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $98.00 | $269.50 | P | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier |
$32.60 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | n/a | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Aetna Medicare Rx Essentials |
$33.20 | $195 | No Gap Coverage | 2 | Tier 2 - Non-Preferred Generic | $12.00 | $24.00 | P | |
Browse Plan Formulary | |||||||||
BravoRx |
$36.50 | $295 | No Gap Coverage | 2 | Tier 2 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
SierraRx |
$36.80 | $0 | No Gap Coverage | 1 | Generic | $9.75 | $29.25 | P | |
Browse Plan Formulary | |||||||||
Advantage Star Plan by RxAmerica |
$37.70 | $295 | No Gap Coverage | 1 | Preferred Generic | $5.25 | $0.00 | P | |
Browse Plan Formulary | |||||||||
MedicareRx Rewards Value |
$37.70 | $130 | No Gap Coverage | 1 | Tier 1 Preferred Generic | $9.50 | $14.25 | P | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver |
$38.30 | $295 | No Gap Coverage | 2 | Tier 2 Non Preferred Generics | $31.00 | $93.00 | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
CIGNA Medicare Rx Plan One |
$38.50 | $295 | No Gap Coverage | 2 | Tier 2 | $33.00 | $82.50 | P | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-089 |
$38.90 | $295 | No Gap Coverage | 1 | Preferred Generic | 15% | 15% | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver |
$40.00 | $295 | No Gap Coverage | 1 | Tier 1 - Preferred Generic | $5.00 | $0.00 | P | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-029 |
$40.00 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | $0.00 | P | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$40.20 | $295 | No Gap Coverage | 2 | Preferred Brand | $44.00 | $88.00 | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$42.90 | $0 | No Gap Coverage | 1 | Tier 1-Preferred Generic | $7.00 | $0.00 | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
AdvantraRx Premier |
$43.20 | $0 | No Gap Coverage | 1 | Preferred Generic | $6.00 | $12.00 | P | |
Browse Plan Formulary | |||||||||
Advantage Freedom Plan by RxAmerica |
$44.00 | $0 | No Gap Coverage | 1 | Preferred Generic | $5.00 | $0.00 | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$44.10 | $0 | No Gap Coverage | 3 | Tier 3 | $38.00 | $95.00 | P | |
Browse Plan Formulary | |||||||||
Educators Rx Basic |
$47.10 | $295 | No Gap Coverage | 2 | Preferred Brand | $30.00 | $90.00 | P | |
Browse Plan Formulary | |||||||||
UA Medicare Part D Rx Covg - Silver Plan |
$47.70 | $110 | No Gap Coverage | 2 | Preferred Brand | $40.00 | $100.00 | P | |
Browse Plan Formulary | |||||||||
UA Medicare Part D Prescription Drug Cov |
$47.90 | $0 | No Gap Coverage | 2 | Preferred Brand | $33.00 | $66.00 | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
UnitedHealth Rx Basic |
$48.70 | $0 | No Gap Coverage | 1 | Tier 1 - Preferred Generic | $7.00 | $0.00 | P | |
Browse Plan Formulary | |||||||||
Health Net Value Orange Option 2 |
$48.90 | $0 | No Gap Coverage | 2 | Preferred Brand | $39.00 | $78.00 | P | |
Browse Plan Formulary | |||||||||
Medco Medicare Prescription Plan - Choice |
$49.80 | $0 | No Gap Coverage | 2 | Preferred Brand | $38.00 | $95.00 | P | |
Browse Plan Formulary | |||||||||
Educators Rx Advantage |
$60.70 | $50 | No Gap Coverage | 2 | Preferred Brand | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier Plus |
$61.30 | $0 | Many Generics | 1 | Preferred Generic | $4.00 | $8.00 | P | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold |
$61.80 | $0 | No Gap Coverage | 2 | Tier 2 NonPreferred Generic | $45.00 | $135.00 | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Aetna Medicare Rx - Costco Plus Plan |
$64.70 | $0 | Some Generics | 2 | Tier 2 - Non-Preferred Generic | $5.00 | $20.00 | P | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$65.70 | $50 | Many Generics | 5 | Non-Preferred Brand | $95.00 | $261.00 | P | |
Browse Plan Formulary | |||||||||
Regence Medicare Script |
$66.50 | $295 | No Gap Coverage | 1 | Generic | $4.00 | $12.00 | P | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced |
$72.90 | $0 | Many Generics | 1 | Tier 1 - Preferred Generic | $7.00 | $0.00 | P | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$73.20 | $0 | Some Generics | 2 | Tier 2 | $35.00 | $87.50 | P | |
Browse Plan Formulary | |||||||||
SierraRx Basic |
$78.00 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | P | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Medco Medicare Prescription Plan - Access |
$79.60 | $0 | All Generics | 2 | Preferred Brand | $35.00 | $87.50 | P | |
Browse Plan Formulary | |||||||||
Regence Medicare Script Enhanced |
$83.50 | $0 | Many Generics | 1 | Generic | $4.00 | $12.00 | P | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$84.60 | $0 | Many Generics | 4 | Non-Preferred Brand | $98.00 | $270.00 | P | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-059 |
$98.30 | $0 | Many Generics | 1 | Preferred Generic | $7.00 | $0.00 | P | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier |
$113.70 | $0 | Many Generics | 2 | Tier 2 - Non-Preferred Generic | $10.00 | $20.00 | P | |
Browse Plan Formulary |
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