SAVELLA TABLETS 12.5MG 60 COUNT BOTTLE (60 COUNT BOT) (NDC: 00456151260)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Additional Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC FL-0006 (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $494.41 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0019 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $493.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0031 (Regional PPO)
|
$0.00 |
$395 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $493.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-003P (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $493.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Preferred Brand |
$10.00 | $20.00 | Q:60 /30Days | $483.46 |
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 |
Advantage Care CHF by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Preferred Brand |
$10.00 | $20.00 | Q:60 /30Days | $483.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Advantage Care COPD by Ultimate (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Preferred Brand |
$10.00 | $20.00 | Q:60 /30Days | $481.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
BayCarePlus Complete (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:60 /30Days | $471.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BayCarePlus Freedom (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:60 /30Days | $471.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BayCarePlus Rewards (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $125.00 | Q:60 /30Days | $471.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BayCarePlus Value (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $125.00 | Q:60 /30Days | $471.34 |
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 |
CareBreeze Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$40.00 | $110.00 | Q:60 /30Days | $464.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareComplete Platinum (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$40.00 | $110.00 | Q:60 /30Days | $464.28 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareFree (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:60 /30Days | $465.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareFree (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:60 /30Days | $461.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareOne Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:60 /30Days | $461.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareOne Plus (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:60 /30Days | $465.13 |
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 |
Devoted CHOICE GIVEBACK Tampa (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Tampa (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted CORE Tampa (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted ESSENTIALS Tampa (HMO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted ESSENTIALS Tampa (HMO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$40.00 | $40.00 | Q:60 /30Days | $473.02 |
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 |
Honest Care (HMO-POS)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$40.00 | $40.00 | Q:60 /30Days | $473.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:60 /30Days | $464.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $463.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-025 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$5.00 | $5.00 | Q:60 /30Days | $465.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-265 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $464.65 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-265 (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $464.50 |
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 Lung (HMO C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $463.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-072 (PPO)
|
$0.00 |
$150 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $463.77 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-304 (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $463.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-393 (PPO)
|
$0.00 |
$350* | No additional gap coverage, only the Donut Hole Discount | 3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $464.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier by Ultimate (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 2 |
Preferred Brand |
$15.00 | $30.00 | Q:60 /30Days | $483.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$40.00 | $40.00 | Q:60 /30Days | $473.02 |
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 Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $485.78 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $487.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $485.23 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care Walgreens FL-0014 (HMO-POS C-SNP)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $483.08 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Giveback (HMO)
|
$0.00 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
49% | 49% | P Q:60 /30Days | $535.03 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare No Premium (HMO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days | $535.03 |
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 Open (PPO)
|
$0.00 |
$100 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
40% | 40% | P Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted DUAL PLUS Florida (HMO D-SNP)
|
$16.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted DUAL Tampa (HMO D-SNP)
|
$19.00 |
$545 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PREMIUM Florida (HMO)
|
$21.90 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PREMIUM Florida (HMO)
|
$21.90 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PREMIUM Florida (HMO)
|
$21.90 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $456.26 |
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 |
Devoted PREMIUM Florida (HMO)
|
$21.90 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
Devoted PREMIUM Florida (HMO)
|
$21.90 |
$545 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
25% | 25% | P Q:60 /30Days | $456.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-392 (PPO)
|
$22.00 |
$150* | No additional gap coverage, only the Donut Hole Discount | 3* |
Preferred Brand |
$30.00 | $80.00 | Q:60 /30Days | $464.11 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Access Open (PPO D-SNP)
|
$25.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Complete (HMO-POS C-SNP)
|
$25.80 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:60 /30Days | $473.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareNeeds Plus (HMO D-SNP)
|
$28.20 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $464.28 |
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 |
Advantage Plus by Ultimate (Full) (HMO D-SNP)
|
$29.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
25% | 25% | Q:60 /30Days | $482.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Fully Integrated H1036-280 (HMO D-SNP)
|
$29.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $463.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5826-074 (Regional PPO)
|
$31.00 |
$395 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $464.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP)
|
$31.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $463.79 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
|
$32.40 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $493.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareNeeds Platinum (HMO D-SNP)
|
$32.50 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $464.46 |
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 |
Advantage Plus by Ultimate (Partial) (HMO D-SNP)
|
$32.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
25% | 25% | Q:60 /30Days | $482.14 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP)
|
$32.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $464.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare All Dual (HMO D-SNP)
|
$34.10 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | P Q:60 /30Days | $543.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Complete (HMO-POS C-SNP)
|
$36.30 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:60 /30Days | $473.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Dual Liberty (HMO D-SNP)
|
$37.60 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
$0.00 | $0.00 | P Q:60 /30Days | $543.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | Q:60 /30Days | $464.11 |
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 |
Longevity Health Plan (HMO I-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | n/a | Q:60 /30Days | $459.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
|
$37.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$47.00 | $131.00 | None | $493.24 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D002 (HMO-POS D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | None | $493.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | None | $492.70 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | None | $493.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D005 (Regional PPO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | None | $493.23 |
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 Reserve (HMO D-SNP)
|
$37.70 |
$545 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | P Q:60 /30Days | $543.21 |
Browse Plan Formulary all covered insulin pay $35 or less |
BayCarePlus Premier (HMO)
|
$42.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$30.00 | $80.00 | Q:60 /30Days | $471.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
Wellcare Premium Enhanced Open (PPO)
|
$93.00 |
$0 | Yes, but No Gap Coverage for this drug. | 4 |
Non-Preferred Drug |
46% | 46% | P Q:60 /30Days | tbd |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5826-005 (Regional PPO)
|
$173.00 |
$100 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $464.15 |
Browse Plan Formulary all covered insulin pay $35 or less |