There are 24 stand-alone Medicare Part D plans in Indiana 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
ROXICET 5/500 CAPLET (100 BOT) (NDC: 00054478425) 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 |
||||||
SilverScript Value |
$28.00 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $98.00 | $269.50 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Saver |
$28.20 | $295 | No Gap Coverage | 1 | Tier 1 - Preferred Generic | $5.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan One |
$33.50 | $295 | No Gap Coverage | 1 | Tier 1 | $2.50 | $6.25 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials |
$33.90 | $200 | No Gap Coverage | 4 | Tier 4 - Non-Preferred Brand | $70.00 | $140.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 1 |
$34.80 | $295 | No Gap Coverage | 2 | Preferred Brand | $42.00 | $84.00 | 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 |
|
WellCare Classic |
$34.90 | $295 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Silver |
$35.00 | $295 | No Gap Coverage | 1 | Tier 1 Preferred Generic | $4.00 | $12.00 | None | |
Browse Plan Formulary | |||||||||
WellCare Signature |
$38.40 | $0 | No Gap Coverage | 1 | Tier 1 | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Two |
$41.20 | $0 | No Gap Coverage | 2 | Tier 2 | $6.00 | $15.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$41.90 | $0 | No Gap Coverage | 1 | Tier 1-Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-073 |
$42.10 | $295 | No Gap Coverage | 1 | Preferred Generic | 15% | 15% | Q:240 /30Days | |
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 |
$42.40 | $295 | No Gap Coverage | 1 | Generic | $7.00 | $14.00 | None | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic |
$44.00 | $0 | No Gap Coverage | 1 | Tier 1 - Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-013 |
$47.90 | $0 | No Gap Coverage | 1 | Preferred Generic | $7.00 | $0.00 | Q:240 /30Days | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$51.30 | $50 | Many Generics | 5 | Non-Preferred Brand | $95.00 | $261.00 | None | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus |
$58.80 | $0 | Some Generics | 4 | Tier 4 - Non-Preferred Brand | $78.00 | $156.00 | None | |
Browse Plan Formulary | |||||||||
Health Net Orange Option 2 |
$62.00 | $0 | No Gap Coverage | 2 | Preferred Brand | $30.00 | $60.00 | 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 |
|
SierraRx Basic |
$65.70 | $295 | No Gap Coverage | 1 | Tier 1 | 25% | 25% | Q:240 /30Days | |
Browse Plan Formulary | |||||||||
CIGNA Medicare Rx Plan Three |
$66.10 | $0 | Some Generics | 1 | Tier 1 | $6.00 | $15.00 | None | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$66.90 | $0 | Many Generics | 4 | Non-Preferred Brand | $98.00 | $270.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced |
$71.70 | $0 | Many Generics | 1 | Tier 1 - Preferred Generic | $7.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
EnvisionRxPlus Gold |
$72.30 | $0 | No Gap Coverage | 1 | Tier 1 Preferred Generics | $0.00 | $0.00 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-043 |
$98.40 | $0 | Many Generics | 1 | Preferred Generic | $7.00 | $0.00 | Q:240 /30Days | |
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 Premier |
$100.90 | $0 | Many Generics | 4 | Tier 4 - Non-Preferred Brand | $65.00 | $130.00 | None | |
Browse Plan Formulary |
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