LEVO-T 88 MCG TABLET (NDC: 55466010711)
2019 Medicare Prescription Drug Plan (MAPD) Information
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $9.26 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $9.26 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $9.26 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $9.26 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Heart & Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Alignment Health Plan Heart & Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Heart & Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.05 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$1.00 | $2.50 | None | $13.05 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$1.00 | $2.50 | None | $13.05 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.05 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.05 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$5.00 | $12.50 | None | $13.05 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Alignment Health Plan smartHMO (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$5.00 | $12.50 | None | $13.05 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $14.98 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $14.98 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $14.98 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Best Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Best Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Easy Choice Freedom Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Easy Choice Freedom Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$415* |
to be determined |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Golden State (HMO)
![Email Prescription and/or Health Benefit details for Golden State (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $13.41 |
Browse Plan Formulary |
Golden State (HMO)
![Email Prescription and/or Health Benefit details for Golden State (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $13.41 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $13.00 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | None | $13.00 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Jade (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $14.97 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $14.97 |
Browse Plan Formulary |
Imperial Senior Value (HMO SNP) (HMO SNP)
![Email Prescription and/or Health Benefit details for Imperial Senior Value (HMO SNP) (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.24 |
Browse Plan Formulary |
Imperial Traditional (HMO) (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional (HMO) (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $8.24 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $30.00 | None | $21.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$15.00 | $30.00 | None | $21.85 |
Browse Plan Formulary |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $13.99 |
Browse Plan Formulary |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | None | $13.99 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Generic Drugs |
0% | 0% | None | $11.82 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Generic Drugs |
0% | 0% | None | $11.82 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$415 |
to be determined |
2 |
Generic |
$8.00 | $24.00 | None | $11.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Generic |
$17.00 | $34.00 | None | $21.85 |
Browse Plan Formulary |
Easy Choice Rx (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$415* |
to be determined |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Easy Choice Rx (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.50 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $30.00 | None | $21.85 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.50 |
$0 |
to be determined |
2 |
Generic |
$15.00 | $30.00 | None | $21.85 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.20 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$8.00 | $24.00 | None | $11.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | None | $13.27 |
Browse Plan Formulary |
Easy Choice Freedom Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Easy Choice Freedom Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.30 |
$415* |
to be determined |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.30 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.07 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$415 |
to be determined |
1 |
Preferred Generic |
$5.00 | $15.00 | None | $13.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Alignment Health Plan CalPlus (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $15.00 | None | $13.07 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$415 |
to be determined |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $14.97 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | None | $14.97 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber I (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$320 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber I (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$320 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
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Health Net Seniority Plus Amber II (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$300 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Amber II (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
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Health Net Seniority Plus Amber II (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$300 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$300 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$340 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$340 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$340 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$340 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
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Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$340 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$340 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$285 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Sapphire Premier (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$285 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier II (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$280 |
to be determined |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier II (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$280 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$20.00 | $60.00 | None | $13.20 |
Browse Plan Formulary |
Imperial Traditional Plus (HMO) (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional Plus (HMO) (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$415* |
to be determined |
1* |
Preferred Generic |
0% | 0% | None | $8.24 |
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Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$17.00 | $34.00 | None | $21.85 |
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Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.90 |
$0 |
to be determined |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $9.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $9.26 |
Browse Plan Formulary |