ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES (30 BLPK CRTN) (NDC: 00555108301)
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 |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $693.66 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$65.00 | $195.00 | P Q:120 /30Days | $561.75 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.05 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.05 |
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 | $684.05 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:4 /1Days | $629.34 |
Browse Plan Formulary |
Humana Gold Plus H0307-011 (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
SCAN Health Plan Arizona (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
25% | n/a | P Q:120 /30Days | $586.31 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
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 |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
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)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
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 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
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 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$15.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:4 /1Days | $629.34 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:4 /1Days | $629.34 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:4 /1Days | $629.34 |
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 |
5 |
Tier 5 |
33% | n/a | P Q:4 /1Days | $629.34 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:4 /1Days | $629.34 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:4 /1Days | $629.34 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
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)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Humana Gold Plus H0307-008 (HMO)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Plus H0307-010 (HMO-POS)
|
$19.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Mercy Care Advantage (HMO)
|
$19.60 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | P Q:136 /34Days | $615.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
3 |
Tier 3 |
$6.30 | $6.30 | P Q:120 /30Days | $656.18 |
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 Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
3 |
Tier 3 |
$6.30 | $6.30 | P Q:120 /30Days | $656.18 |
Browse Plan Formulary |
Health Net Amber (HMO)
|
$24.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:4 /1Days | $629.34 |
Browse Plan Formulary |
Abrazo Advantage Plus (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | n/a | P Q:120 /30Days | $656.18 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$24.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Abrazo Advantage (HMO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | 20% | P Q:120 /30Days | $656.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $648.38 |
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 H2944-028 (PFFS)
|
$25.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $648.38 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-030 (PFFS)
|
$33.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $648.38 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
HumanaChoice R5826-076 (Regional PPO)
|
$34.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
HumanaChoice H0317-002 (PPO)
|
$36.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
HumanaChoice R5826-014 (Regional PPO)
|
$38.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
HumanaChoice H0317-001 (PPO)
|
$50.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |