GUANFACINE HCL ER 2 MG TABLET ER 24H [Intuniv] (30 TABLETS ) (NDC: 24979053401)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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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 from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
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 |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0001 (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0004 (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Elite 3 (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Elite (HMO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Value (HMO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Credit (PPO)
|
$0.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (HMO-POS)
|
$0.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Value (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Value Plan (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Core (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Core (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Core (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Core (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Core (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AmeriHealth Medicare Core (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Core (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Secure (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Secure (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Secure (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Secure (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AmeriHealth Medicare Secure (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Secure (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Secure (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Ultimate (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Ultimate (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Ultimate (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AmeriHealth Medicare Ultimate (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Ultimate (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Ultimate (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Ultimate (PPO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.58 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $18.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $18.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $18.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $17.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $17.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $17.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $17.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $17.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $15.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $15.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Braven Medicare Choice (PPO)
|
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $19.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $19.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $19.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $19.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $35.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $36.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $125.00 | P Q:30 /30Days | $40.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier (PPO)
|
$0.00 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 22% | P Q:30 /30Days | $37.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Guardian (HMO-POS I-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$70.00 | $200.00 | None | $19.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Guardian (HMO-POS I-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$70.00 | $200.00 | None | $19.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Erickson Advantage Guardian (HMO-POS I-SNP)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$70.00 | $200.00 | None | $19.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Liberty (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Liberty (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Liberty (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-063 (HMO)
|
$0.00 |
$225* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H6622-066 (HMO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-169 (PPO)
|
$0.00 |
$275* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-172 (PPO)
|
$0.00 |
$295* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-185 (PPO)
|
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-319 (PPO)
|
$0.00 |
$545* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.42 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-320 (PPO)
|
$0.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Silver (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Silver (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Jefferson Health Plans Silver (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Silver (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Silver (HMO-POS)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 No Premium (HMO-POS)
|
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Focus (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $31.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Focus (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $31.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium Focus (HMO)
|
$0.00 |
$375 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $31.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Medicare Advantage (HMO)
|
$0.00 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days | $12.84 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Bronze Plan (PPO)
|
$15.00 |
$250* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Platinum (HMO-POS)
|
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Platinum (HMO-POS)
|
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Platinum (HMO-POS)
|
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Jefferson Health Plans Platinum (HMO-POS)
|
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Jefferson Health Plans Platinum (HMO-POS)
|
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $20.00 | Q:30 /30Days | $23.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP)
|
$25.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.49 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Assist (HMO)
|
$27.10 |
$410 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Extra Help (HMO)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Extra Help (HMO)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Extra Help (HMO)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Extra Help (HMO)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Extra Help (HMO)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Extra Help (HMO)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Extra Help (HMO)
|
$28.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan NJ-F001 (HMO I-SNP)
|
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $20.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Premier Value (PPO)
|
$31.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.35 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan EX-F003 (PPO I-SNP)
|
$33.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $19.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Kidney Care (HMO-POS C-SNP)
|
$33.90 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$94.00 | $282.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage NJ-E001 (PPO I-SNP)
|
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $19.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Discover Value Plan (PPO)
|
$35.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.06 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
Braven Medicare Freedom (PPO)
|
$35.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:30 /30Days | $16.38 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $19.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $19.07 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $16.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Plus Medicare (PPO)
|
$35.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | Q:30 /30Days | $18.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health LiveHealthy Value (PPO)
|
$35.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage (HMO D-SNP)
|
$35.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Value (HMO)
|
$35.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Value (HMO)
|
$35.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Value (HMO)
|
$35.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Value (HMO)
|
$35.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Value (HMO)
|
$35.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Value (HMO)
|
$35.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Value (HMO)
|
$35.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.32 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SNJ Prime Elite (PPO)
|
$37.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Enhanced (PPO)
|
$37.30 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Enhanced (PPO)
|
$37.30 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AmeriHealth Medicare Enhanced (PPO)
|
$37.30 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Enhanced (PPO)
|
$37.30 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Enhanced (PPO)
|
$37.30 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Enhanced (PPO)
|
$37.30 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
AmeriHealth Medicare Enhanced (PPO)
|
$37.30 |
$300 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:30 /30Days | $7.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Choice Value (PPO)
|
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
22% | 22% | P Q:30 /30Days | $41.54 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0005 (PPO)
|
$38.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (PPO I-SNP)
|
$38.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $14.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Prime Premier (PPO)
|
$39.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-170 (PPO)
|
$39.00 |
$250* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days | $9.47 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-186 (PPO)
|
$39.00 |
$505* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $9.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Assure Premier Plus (HMO D-SNP)
|
$39.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0002 (HMO-POS)
|
$41.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Clover Health Choice Value (PPO)
|
$42.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
23% | 22% | P Q:30 /30Days | $36.40 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Low Premium Open (PPO)
|
$43.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:30 /30Days | $33.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$43.70 |
$495 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | P Q:30 /30Days | $36.25 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP)
|
$44.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P Q:30 /30Days | $12.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete NJ-Y001 (HMO D-SNP)
|
$45.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
$0.00 | $0.00 | None | $19.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Horizon NJ TotalCare (HMO D-SNP)
|
$45.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $15.83 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (HMO-POS)
|
$57.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.73 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Freedom (HMO-POS)
|
$64.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Freedom (HMO-POS)
|
$64.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Freedom (HMO-POS)
|
$64.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC NJ-0003 (HMO-POS)
|
$77.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $19.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier 2 (PPO)
|
$79.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Premier 2 (PPO)
|
$79.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier 2 (PPO)
|
$79.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier 2 (PPO)
|
$79.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier 2 (PPO)
|
$79.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier 2 (PPO)
|
$79.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier 2 (PPO)
|
$79.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Premier Plus (HMO-POS)
|
$84.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $13.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Explorer Premier (PPO)
|
$87.00 |
$150* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$0.00 | $0.00 | P Q:30 /30Days | $14.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier (Regional PPO)
|
$111.00 |
$300* |
Yes, this drug has Gap Coverage. |
2* |
Generic |
$5.00 | $0.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Erickson Advantage Signature (HMO-POS)
|
$168.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Signature (HMO-POS)
|
$168.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Signature (HMO-POS)
|
$168.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Platinum Plan (PPO)
|
$170.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$10.00 | $10.00 | P Q:30 /30Days | $13.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Erickson Advantage Champion (HMO-POS C-SNP)
|
$188.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Champion (HMO-POS C-SNP)
|
$188.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Erickson Advantage Champion (HMO-POS C-SNP)
|
$188.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$85.00 | $245.00 | None | $19.76 |
Browse Plan Formulary all covered insulin pay $35 or less |