SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE (30 TAB BOTTLE in CARTON ) (NDC: 00003085222)
2021 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
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 |
AARP Medicare Advantage Plan 7 (HMO)
|
$0.00 |
$175 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:30 /30Days | $16,185.30 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Walgreens (PPO)
|
$0.00 |
$225 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:30 /30Days | $16,149.30 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $16,009.80 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
30% | n/a | P | $16,009.80 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P | $16,009.80 |
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 |
Allwell Medicare (HMO)
|
$0.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | P | $16,021.80 |
Browse Plan Formulary |
Allwell Medicare Boost (HMO)
|
$0.00 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | P | $16,021.80 |
Browse Plan Formulary |
Anthem MediBlue Essential (HMO)
|
$0.00 |
$60 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $15,992.10 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $15,992.10 |
Browse Plan Formulary |
Anthem MediBlue Prime Select (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $15,946.20 |
Browse Plan Formulary |
Bright Advantage University Hospitals (HMO)
|
$0.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $15,396.60 |
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 |
Bright Advantage University Hospitals Choice (PPO)
|
$0.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $15,396.60 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
|
$0.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:30 /30Days | $14,699.40 |
Browse Plan Formulary |
CareSource MyCare Ohio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $14,647.80 |
Browse Plan Formulary |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $16,731.30 |
Browse Plan Formulary |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $16,731.30 |
Browse Plan Formulary |
Devoted Health Core (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $14,853.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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 |
Devoted Health Saver (HMO)
|
$0.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P | $14,853.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Cleveland Clinic Preferred (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H6622-014 (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5525-042 (PPO)
|
$0.00 |
$250 |
No |
5 |
Specialty Tier |
28% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,476.50 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,538.90 |
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 |
MedMutual Advantage Classic (HMO)
|
$0.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $15,034.50 |
Browse Plan Formulary |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $15,034.50 |
Browse Plan Formulary |
MedMutual Advantage Signature (HMO)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $14,538.90 |
Browse Plan Formulary |
Paramount Elite - Standard Medical & Drug (HMO)
|
$0.00 |
$50 |
No |
5 |
Specialty Tier |
32% | n/a | P | $14,747.70 |
Browse Plan Formulary |
PrimeTime Health Plan Aultimate (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P | $14,805.60 |
Browse Plan Formulary |
SummaCare Medicare Topaz (HMO)
|
$0.00 |
$150* |
No |
5* |
Specialty Tier |
30% | n/a | P Q:30 /30Days | $14,776.80 |
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 |
UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:30 /30Days | $16,183.80 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P | $16,023.00 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
|
$0.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $16,052.70 |
Browse Plan Formulary |
Allwell Medicare Complement (HMO)
|
$9.60 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P | $16,023.30 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$15.00 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-106 (PPO)
|
$15.00 |
$125 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:60 /30Days | $15,918.90 |
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 |
Anthem MediBlue Preferred Plus (HMO)
|
$19.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $15,992.10 |
Browse Plan Formulary |
Humana Gold Plus H6622-070 (HMO)
|
$20.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MedMutual Advantage Secure (HMO)
|
$20.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $15,034.50 |
Browse Plan Formulary |
MedMutual Advantage Secure (HMO)
|
$20.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,538.90 |
Browse Plan Formulary |
AARP Medicare Advantage Plan 1 (HMO)
|
$21.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:30 /30Days | $16,185.30 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Allwell Dual Medicare (HMO D-SNP)
|
$21.10 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P | $16,023.60 |
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 |
CareSource Advantage (HMO)
|
$21.60 |
$75 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,699.40 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
|
$22.00 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $16,185.30 |
Browse Plan Formulary |
Devoted Health Prime (HMO)
|
$22.80 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P | $14,853.60 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier Plus 2 (Regional PPO)
|
$25.30 |
$190 |
No |
5 |
Specialty Tier |
29% | n/a | P | $16,009.80 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
|
$25.30 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $15,992.10 |
Browse Plan Formulary |
Aetna Medicare Assure 1 (HMO D-SNP)
|
$26.20 |
$220 |
No |
5 |
Specialty Tier |
29% | n/a | P | $16,009.80 |
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 Assure (HMO D-SNP)
|
$27.50 |
$130 |
No |
5 |
Specialty Tier |
30% | n/a | P | $16,009.80 |
Browse Plan Formulary |
Paramount Elite - Prime Medical & Drug (HMO)
|
$28.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $14,747.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
SummaCare Medicare Garnet (HMO)
|
$29.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $14,841.00 |
Browse Plan Formulary |
SummaCare Medicare Garnet (HMO)
|
$29.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $14,718.30 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO D-SNP)
|
$29.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $15,992.10 |
Browse Plan Formulary |
CareSource Dual Advantage (HMO D-SNP)
|
$29.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $14,699.40 |
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 |
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)
|
$29.80 |
$420 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$29.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P | $14,745.90 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$29.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P | $14,745.90 |
Browse Plan Formulary |
Provider Partners Ohio Advantage Plan (HMO I-SNP)
|
$29.80 |
$445 |
No |
1 |
Tier 1 |
25% | 25% | P Q:60 /30Days | $15,280.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO D-SNP)
|
$29.80 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $16,185.30 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)
|
$29.80 |
$445 |
No |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $16,184.40 |
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 |
Valor Health Plan (HMO I-SNP)
|
$29.80 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | P Q:60 /30Days | $15,396.60 |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
|
$29.80 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P | $16,052.70 |
Browse Plan Formulary |
Bright Advantage University Hospitals Choice Plus (PPO)
|
$34.00 |
$445 |
No |
5 |
Specialty Tier |
25% | n/a | P Q:60 /30Days | $15,396.60 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $15,034.50 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,476.50 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
|
$34.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,538.90 |
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 |
The Health Plan SecureCare - Option II (HMO)
|
$35.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,585.10 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
|
$36.10 |
$200 |
No |
5 |
Specialty Tier |
29% | n/a | P Q:30 /30Days | $15,992.10 |
Browse Plan Formulary |
The Health Plan SecureCare SNP (HMO D-SNP)
|
$37.00 |
$445 |
No |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $14,688.60 |
Browse Plan Formulary |
Aetna Medicare Premier Plus 1 (Regional PPO)
|
$38.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $16,009.80 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $15,034.50 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,476.50 |
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 |
MedMutual Advantage Select (PPO)
|
$38.00 |
$95 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,538.90 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
|
$39.00 |
$380 |
No |
5 |
Specialty Tier |
26% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary |
PrimeTime Health Plan Classic (HMO-POS)
|
$39.00 |
$150 |
No |
5 |
Specialty Tier |
30% | n/a | P | $14,805.60 |
Browse Plan Formulary |
SummaCare Medicare Ruby (HMO)
|
$43.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $14,776.80 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$55.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $16,002.30 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
|
$65.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $15,969.00 |
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 |
Anthem MediBlue Access (PPO)
|
$65.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $15,997.20 |
Browse Plan Formulary |
Paramount Elite - Enhanced Medical & Drug (HMO)
|
$68.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $14,747.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $15,034.50 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,476.50 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
|
$74.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,538.90 |
Browse Plan Formulary |
HumanaChoice H5216-024 (PPO)
|
$75.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:60 /30Days | $15,918.90 |
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 |
SummaCare Medicare Sapphire (HMO-POS)
|
$76.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $14,776.80 |
Browse Plan Formulary |
The Health Plan SecureChoice - Option II (PPO)
|
$79.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $14,585.10 |
Browse Plan Formulary |
Anthem MediBlue Access Plus (PPO)
|
$89.00 |
$40 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $15,983.10 |
Browse Plan Formulary |
PrimeTime Health Plan Plus (HMO-POS)
|
$89.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | P | $14,805.60 |
Browse Plan Formulary |
Humana Gold Plus H6622-019 (HMO)
|
$90.00 |
$125 |
No |
5 |
Specialty Tier |
30% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $15,034.50 |
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 |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,476.50 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
|
$95.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,538.90 |
Browse Plan Formulary |
AARP Medicare Advantage Plan 3 (HMO)
|
$111.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $16,184.70 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Premier 2 (PPO)
|
$124.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P | $16,009.80 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $15,034.50 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,476.50 |
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 |
MedMutual Advantage Premium (PPO)
|
$128.00 |
$55 |
No |
5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $14,538.90 |
Browse Plan Formulary |
Aetna Medicare Premier 1 (PPO)
|
$140.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Specialty Tier |
30% | n/a | P | $16,009.80 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
|
$155.00 |
$100 |
No |
5 |
Specialty Tier |
31% | n/a | P Q:60 /30Days | $15,918.90 |
Browse Plan Formulary |
SummaCare Medicare Emerald (HMO-POS)
|
$180.00 |
$0 |
No |
5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $14,776.80 |
Browse Plan Formulary |