FENTORA TABLET 400MCG (28 BLPK) (NDC: 63459054428)
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 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $985.35 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $915.50 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $915.50 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $915.50 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$59.00 | $118.00 | None | $915.50 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
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 | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
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 | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
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 | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
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 | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
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 | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,051.97 |
Browse Plan Formulary |
Clear Care Vital (HMO)
|
$10.00 |
$310 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,014.08 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
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 |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
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 |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
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 |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
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 |
SecureHorizons MedicareDirect Rx Plan 59 (
|
$12.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $978.60 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$12.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $985.35 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$17.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $1,017.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$19.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $984.96 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$19.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $984.96 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$19.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $984.96 |
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 |
Evercare Plan MH (HMO)
|
$19.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $984.96 |
Browse Plan Formulary |
Clear Care Essential (HMO)
|
$27.40 |
$310 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,014.08 |
Browse Plan Formulary |
Regence MedAdvantage + Rx Classic (PPO)
|
$38.80 |
$255 | to be determined | 3 |
Tier 3 |
$56.00 | $168.00 | P Q:84 /30Days | $988.99 |
Browse Plan Formulary |
Clear Care Optimal (HMO)
|
$40.10 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,014.08 |
Browse Plan Formulary |
Regence MedAdvantage + Rx Enhanced (PPO)
|
$66.60 |
$0 | to be determined | 3 |
Tier 3 |
$56.00 | $168.00 | P Q:84 /30Days | $988.99 |
Browse Plan Formulary |