There are 25 stand-alone Medicare Part D plans in New Hampshire 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
IMIPRAMINE PAMOATE 75MG CAPSULE (30 BOT) (NDC: 00406993103) 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 |
||||||
WellCare Classic![]() ![]() |
$21.20 | $250 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
HealthSpring Prescription Drug Plan -Reg 1![]() ![]() |
$26.10 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver![]() ![]() |
$27.10 | $295 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $59.65 | $163.95 | None | |
Browse Plan Formulary | |||||||||
SilverScript Value![]() ![]() |
$27.10 | $295 | No Gap Coverage | 1 | Generic | $8.00 | $12.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Signature![]() ![]() |
$28.80 | $0 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
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![]() ![]() |
$30.50 | $295 | No Gap Coverage | 1 | Tier 1 | $2.50 | $6.25 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials![]() ![]() |
$31.20 | $205 | No Gap Coverage | 2 | Tier 2 - Non-Preferred Generic | $12.00 | $24.00 | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver![]() ![]() |
$34.20 | $295 | No Gap Coverage | 1 | Tier 1 Preferred Generic | $4.00 | $12.00 | None | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Value![]() ![]() |
$35.00 | $130 | No Gap Coverage | 1 | Tier 1 Preferred Generic | $10.00 | $15.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred![]() ![]() |
$35.50 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $98.00 | $279.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two![]() ![]() |
$37.20 | $0 | No Gap Coverage | 2 | Tier 2 | $6.00 | $15.00 | None | |
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 |
|
Sterling Rx![]() ![]() |
$37.50 | $295 | No Gap Coverage | 1 | Generic | $7.00 | $14.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-092![]() ![]() |
$39.20 | $295 | No Gap Coverage | 1 | Preferred Generic | 15% | 15% | None | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic![]() ![]() |
$40.80 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $98.00 | $279.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-095![]() ![]() |
$42.50 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Plus![]() ![]() |
$45.30 | $50 | Many Generics | 2 | Generic | $9.00 | $23.00 | None | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Value Plus![]() ![]() |
$45.50 | $0 | No Gap Coverage | 1 | Tier 1 Preferred Generic | $9.00 | $13.50 | None | |
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 |
|
EnvisionRxPlus Gold![]() ![]() |
$56.50 | $0 | No Gap Coverage | 1 | Tier 1 Preferred Generics | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus![]() ![]() |
$61.20 | $0 | Some Generics | 2 | Tier 2 - Non-Preferred Generic | $10.00 | $20.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Complete![]() ![]() |
$62.00 | $0 | Many Generics | 2 | Generic | $7.50 | $19.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three![]() ![]() |
$67.60 | $0 | Some Generics | 1 | Tier 1 | $6.00 | $15.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced![]() ![]() |
$81.70 | $0 | Many Generics | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $95.00 | $270.00 | None | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Premier![]() ![]() |
$81.80 | $0 | Many Generics | 1 | Tier 1 Preferred Generic | $9.00 | $13.50 | None | |
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 |
|
Humana PDP Complete S5884-098![]() ![]() |
$100.20 | $0 | Many Generics | 1 | Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Premier![]() ![]() |
$101.70 | $0 | Many Generics | 2 | Tier 2 - Non-Preferred Generic | $10.00 | $20.00 | None | |
Browse Plan Formulary |
|