OXYCONTIN 15MG TABLET SR 12HR (NDC: 59011081510)
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 |
2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /1Days | $168.44 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $120.00 | Q:60 /30Days | $179.12 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /1Days | $168.40 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /1Days | $168.40 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /1Days | $168.40 |
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 MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /1Days | $168.83 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /1Days | $168.83 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $82.00 | Q:4 /1Days | $169.51 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
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 |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
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 |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | Q:90 /30Days | $180.61 |
Browse Plan Formulary |
Desert Canyon Community Care - Plus (HMO)
|
$8.80 |
$0 |
to be determined |
3 |
Tier 3 |
$44.00 | $88.00 | Q:120 /25Days | $169.44 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx-Dual (HMO)
|
$9.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:60 /30Days | $179.12 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /1Days | $168.45 |
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 |
2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /1Days | $168.45 |
Browse Plan Formulary |
Desert Canyon Community Care - Plus Point
|
$11.60 |
$0 |
to be determined |
3 |
Tier 3 |
$44.00 | $88.00 | Q:120 /25Days | $169.44 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$11.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:4 /1Days | $168.83 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.56 |
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 |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.71 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.71 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.71 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $170.71 |
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 |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
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 |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.56 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$15.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | Q:4 /1Days | $169.49 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | Q:4 /1Days | $169.49 |
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 |
2 |
Tier 2 |
$42.00 | $84.00 | Q:4 /1Days | $169.49 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | Q:4 /1Days | $169.49 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | Q:4 /1Days | $169.49 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $84.00 | Q:4 /1Days | $169.49 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.71 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.71 |
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 |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.71 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.71 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $170.60 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 |
to be determined |
2 |
Tier 2 |
$6.30 | $6.30 | Q:90 /30Days | $174.40 |
Browse Plan Formulary |
Health Net Amber (HMO)
|
$24.70 |
$310 |
to be determined |
2 |
Tier 2 |
$32.00 | $64.00 | Q:4 /1Days | $169.49 |
Browse Plan Formulary |
Abrazo Advantage Plus (HMO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
15% | n/a | Q:90 /30Days | $174.40 |
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 IP (PPO)
|
$24.80 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:4 /1Days | $168.82 |
Browse Plan Formulary |
Abrazo Advantage (HMO)
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $120.00 | Q:90 /30Days | $174.40 |
Browse Plan Formulary |