Peoples Health Group Medicare (HMO-POS)

30-Day Supply: $50 at a retail pharmacy

90-Day Supply: $100 at a retail or mail-order pharmacy with preferred cost-sharing, $150 at a retail or mail-order pharmacy with standard cost-sharing

The costs listed above apply if the drug is covered by Medicare Part D; if the drug is covered by Medicare Part B, the costs may vary. Contact Peoples Health for more information.

If you receive Extra Help from Medicare to pay for your prescription drug costs, your costs will be different. You will pay one of the following costs, depending on your level of Extra Help.

Level 1: $3.95     Level 2: $1.35     Level 3: $0     Level 4: 15% coinsurance

Extra Help is available for people with limited income and resources. Click here for more information about extra help.

Click here to view other drugs in this therapeutic category.

This drug is covered in the coverage gap for Peoples Health Group Medicare (HMO-POS), Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits, Peoples Health Secure Health (HMO D-SNP), Peoples Health Secure Choice (HMO D-SNP), and Peoples Hlth Secure Complete (HMO D-SNP) plan members. Please see your plan’s Evidence of Coverage for more information.