PREZISTA TABLET 75MG (480 BOT) (NDC: 59676056301)
2021 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 |
AARP Medicare Advantage Choice (PPO)
|
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AARP Medicare Advantage Choice Plan 2 (Regional PPO)
|
$0.00 |
$395 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Aetna Medicare Choice (HMO-POS)
|
$0.00 |
$195 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,236.00 |
Browse Plan Formulary |
Aetna Medicare Credit (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,236.00 |
Browse Plan Formulary |
Aetna Medicare Premier (PPO)
|
$0.00 |
$300 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,236.00 |
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 |
Aetna Medicare Select (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$35.00 | $105.00 | Q:480 /30Days | $1,236.00 |
Browse Plan Formulary select insulin pay $20 copay but not this drug |
Align Connect (HMO C-SNP)
|
$0.00 |
$445 |
No |
3 |
Preferred Brand |
$45.00 | n/a | Q:480 /30Days | $1,179.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Align Thrive (HMO I-SNP)
|
$0.00 |
$445 |
No |
3 |
Preferred Brand |
$45.00 | n/a | Q:480 /30Days | $1,179.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AvMed Medicare Access (HMO-POS)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$75.00 | $187.50 | Q:480 /30Days | $1,221.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$70.00 | $175.00 | Q:480 /30Days | $1,221.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
AvMed Medicare Circle (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$65.00 | $162.50 | Q:480 /30Days | $1,221.00 |
Browse Plan Formulary select insulin pay $25-$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 |
BlueMedicare Classic (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:300 /30Days | $1,101.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BlueMedicare Premier (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$50.00 | $150.00 | Q:300 /30Days | $1,101.00 |
Browse Plan Formulary select insulin pay $12 copay but not this drug |
BlueMedicare Saver (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$50.00 | $150.00 | Q:300 /30Days | $1,104.00 |
Browse Plan Formulary select insulin pay $25 copay but not this drug |
BlueMedicare Value (PPO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:300 /30Days | $1,104.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
CareComplete (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$35.00 | $95.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $10-$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 |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$25.00 | $65.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Devoted Health Core Miami-Dade (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$35.00 | $105.00 | Q:480 /30Days | $1,230.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Devoted Health Essentials Miami-Dade (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$85.00 | $255.00 | Q:480 /30Days | $1,230.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
DrCare (HMO-POS C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$40.00 | $120.00 | None | $1,143.00 |
Browse Plan Formulary |
DrExtra (HMO-POS C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$40.00 | $120.00 | None | $1,143.00 |
Browse Plan Formulary |
DrMax (HMO-POS)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$45.00 | $135.00 | None | $1,143.00 |
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 |
DrValue (HMO-POS)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None | $1,143.00 |
Browse Plan Formulary |
HealthSun HealthAdvantage Plan (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$25.00 | n/a | Q:300 /30Days | $1,233.00 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $10-$35 copay but not this drug |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$5.00 | $5.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $5 copay but not this drug |
Humana Gold Plus H1036-237 (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$80.00 | $230.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $20-$35 copay but not this drug |
Humana Gold Plus H1036-237 (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$80.00 | $230.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $20-$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 |
HumanaChoice Florida H5216-068 (PPO)
|
$0.00 |
$150 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$395 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary |
Leon Medicare (HMO)
|
$0.00 |
$0 |
No |
3 |
Non-Preferred Drug |
$40.00 | n/a | None | $1,158.00 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$65.00 | $185.00 | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary select insulin pay $30 copay but not this drug |
MMM ELITE (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$15.00 | $45.00 | Q:480 /30Days | $1,242.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
MMM EXTRA (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,242.00 |
Browse Plan Formulary select insulin pay $0 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 |
PHP (HMO C-SNP)
|
$0.00 |
$445 |
No |
3 |
Non-Preferred Brand |
25% | n/a | None | $1,164.00 |
Browse Plan Formulary |
Preferred Choice Dade (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$40.00 | $110.00 | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary select insulin pay $0 copay but not this drug |
Preferred Special Care Miami-Dade (HMO C-SNP)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$45.00 | $125.00 | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary select insulin pay $15 copay but not this drug |
Simply Care (HMO I-SNP)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Brand |
25% | n/a | Q:300 /30Days | $1,224.00 |
Browse Plan Formulary |
Simply Comfort (HMO I-SNP)
|
$0.00 |
$445 |
No |
4 |
Non-Preferred Brand |
25% | n/a | Q:300 /30Days | $1,224.00 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$100.00 | n/a | Q:300 /30Days | $1,224.00 |
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 |
Simply Level (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Brand |
$10.00 | n/a | Q:300 /30Days | $1,224.00 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Brand |
$5.00 | n/a | Q:300 /30Days | $1,224.00 |
Browse Plan Formulary |
SOLIS SPF 001 (HMO)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
$0.00 | n/a | None | $1,179.00 |
Browse Plan Formulary |
SOLIS SPF 011 (HMO C-SNP)
|
$0.00 |
$0 |
No |
3 |
Preferred Brand |
0% | n/a | None | $1,179.00 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$50.00 | $100.00 | Q:480 /30Days | $1,254.00 |
Browse Plan Formulary |
WellCare Guardian (HMO C-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$50.00 | $100.00 | Q:480 /30Days | $1,254.00 |
Browse Plan Formulary select insulin pay $0 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 |
WellCare Premier (PPO)
|
$0.00 |
$0 |
No |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:480 /30Days | $1,254.00 |
Browse Plan Formulary |
CareExtra (HMO)
|
$16.10 |
$445 |
No |
4 |
Non-Preferred Drug |
24% | 24% | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary select insulin pay $0-$35 copay but not this drug |
CareNeeds PLUS (HMO D-SNP)
|
$16.30 |
$445 |
No |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary |
Humana Fully Integrated H1036-280 (HMO D-SNP)
|
$21.20 |
$445 |
No |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary |
WellCare Reserve (HMO D-SNP)
|
$23.00 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:480 /30Days | $1,254.00 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO D-SNP)
|
$23.60 |
$445 |
No |
4 |
Non-Preferred Drug |
50% | 50% | Q:480 /30Days | $1,254.00 |
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 |
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)
|
$25.70 |
$445 |
No |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary |
Preferred Medicare Assist Plan 1 (HMO D-SNP)
|
$27.10 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
|
$27.20 |
$445 |
No |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary |
Preferred Medicare Assist Plan 2 (HMO D-SNP)
|
$27.20 |
$445 |
No |
4 |
Tier 4 |
$0.00 | $0.00 | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary |
Aetna Medicare Assure Plus (HMO D-SNP)
|
$29.50 |
$250 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,239.00 |
Browse Plan Formulary |
HealthSun MediSun Plus (HMO D-SNP)
|
$29.50 |
$435 |
No |
4 |
Non-Preferred Brand |
25% | n/a | Q:300 /30Days | $1,224.00 |
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 |
WellCare Access (HMO D-SNP)
|
$29.70 |
$445 |
No |
4 |
Non-Preferred Drug |
47% | 47% | Q:480 /30Days | $1,254.00 |
Browse Plan Formulary |
Aetna Medicare Assure (HMO D-SNP)
|
$30.80 |
$250 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,239.00 |
Browse Plan Formulary |
Allwell Medicare Nurture (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
49% | 49% | Q:480 /30Days | $1,254.00 |
Browse Plan Formulary |
BlueMedicare Complete (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
$92.00 | $276.00 | Q:300 /30Days | $1,101.00 |
Browse Plan Formulary |
Devoted Health Dual Miami-Dade (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,230.00 |
Browse Plan Formulary |
Devoted Health Prime Miami-Dade (HMO)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | Q:480 /30Days | $1,230.00 |
Browse Plan Formulary select insulin pay $0 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 |
DrChoice (HMO-POS)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | None | $1,143.00 |
Browse Plan Formulary |
DrFirst (HMO-POS)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | None | $1,143.00 |
Browse Plan Formulary |
DrPlus (HMO-POS D-SNP)
|
$30.80 |
$0 |
No |
4 |
Non-Preferred Drug |
$35.00 | $105.00 | None | $1,143.00 |
Browse Plan Formulary |
HealthSun MediMax (HMO)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Brand |
25% | n/a | Q:300 /30Days | $1,224.00 |
Browse Plan Formulary |
Longevity Health Plan (HMO I-SNP)
|
$30.80 |
$445 |
No |
1 |
Tier 1 |
25% | n/a | None | $1,179.00 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
25% | 25% | Q:60 /30Days | $1,224.00 |
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 |
MMM PLATINUM (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days | $1,242.00 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
33% | 33% | Q:480 /30Days | $1,227.00 |
Browse Plan Formulary |
Simply Complete (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Brand |
$95.00 | n/a | Q:300 /30Days | $1,233.00 |
Browse Plan Formulary |
SOLIS SPF 002 (HMO D-SNP)
|
$30.80 |
$0 |
No |
3 |
Preferred Brand |
0% | n/a | None | $1,179.00 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO I-SNP)
|
$30.80 |
$200 |
No |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $1,224.00 |
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 |
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Tier 4 |
15% | 15% | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO I-SNP)
|
$30.80 |
$445 |
No |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary |
WellCare Liberty (HMO D-SNP)
|
$30.80 |
$445 |
No |
4 |
Non-Preferred Drug |
48% | 48% | Q:480 /30Days | $1,254.00 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO I-SNP)
|
$35.80 |
$445 |
No |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $1,224.00 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$42.90 |
$100 |
No |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:480 /30Days | $1,182.00 |
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 |
BlueMedicare Choice (Regional PPO)
|
$47.90 |
$250 |
No |
4 |
Non-Preferred Drug |
$93.00 | $279.00 | Q:300 /30Days | $1,101.00 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-065 (PPO)
|
$52.00 |
$350 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$101.00 |
$200 |
No |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | Q:480 /30Days | $1,182.00 |
Browse Plan Formulary |