AMPICILLIN CAPSULES 500MG 100 BOT (100 BOT) (NDC: 00781214501)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer 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 MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $24.37 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $24.36 |
Browse Plan Formulary |
CareMore Breathe (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | None | $27.47 |
Browse Plan Formulary |
CareMore Diabetes (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | None | $27.47 |
Browse Plan Formulary |
CareMore Touch (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | None | $27.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | None | $27.47 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $24.20 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $24.20 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $24.20 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $24.29 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $24.29 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $25.16 |
Browse Plan Formulary |
Humana Gold Plus H0307-009 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $31.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.31 |
Browse Plan Formulary |
Desert Canyon Community Care - Plus (HMO)
|
$8.80 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | None | $25.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $24.25 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $24.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $28.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.89 |
Browse Plan Formulary |
Desert Canyon Community Care - Plus Point
|
$11.60 |
$0 |
to be determined |
2 |
Tier 2 |
$12.00 | $24.00 | None | $25.44 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$11.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $24.29 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $29.94 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$15.20 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $25.16 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $25.16 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $25.16 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $25.16 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $25.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $25.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.31 |
Browse Plan Formulary |
Mercy Care Advantage (HMO)
|
$19.60 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $33.32 |
Browse Plan Formulary |
University Physicians Care Advantage (HMO)
|
$19.60 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $44.59 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $24.70 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $44.59 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $44.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Amber (HMO)
|
$24.70 |
$310 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $25.16 |
Browse Plan Formulary |
APIPA Personal Care Plus (HMO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $24.19 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $24.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-030 (PFFS)
|
$33.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-076 (Regional PPO)
|
$34.20 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $27.02 |
Browse Plan Formulary |
HumanaChoice H0317-004 (PPO)
|
$35.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
HumanaChoice R5826-014 (Regional PPO)
|
$38.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $27.02 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $28.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $29.94 |
Browse Plan Formulary |