DECLOMYCIN 300MG TABLET (NDC: 14168287501)
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
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)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:42 /1Days | $1,220.35 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Standard Rx
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std Rx -
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
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 |
Medica Prime Sol. Enhanced w/Enhanced Rx -
|
$67.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $1,155.94 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $68.00 | None | $1,155.94 |
Browse Plan Formulary |