ZERLOR TABLET 712.8MG/60MG (100 BOTPL) (NDC: 18011003201)
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 |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $141.84 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $139.30 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $139.30 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $141.84 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $141.84 |
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 |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $141.84 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $141.84 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $141.84 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $141.84 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $141.84 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
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 | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
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 | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
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 | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
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 | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
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 | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
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 | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $143.41 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
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 |
Aetna Medicare Standard Plan (PPO)
|
$17.80 |
$100* |
to be determined |
2* |
Tier 2 |
$27.00 | $54.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | Q:150 /30Days | $158.60 |
Browse Plan Formulary |
Bravo Premier Plus (HMO-POS)
|
$22.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $139.30 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$29.40 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $141.84 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.50 | $17.00 | None | $143.29 |
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 |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.50 | $17.00 | None | $143.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.50 | $17.00 | None | $143.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.50 | $17.00 | None | $143.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.50 | $17.00 | None | $143.29 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$33.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $139.30 |
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)
|
$33.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $155.88 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | Q:5 /1Days | $149.81 |
Browse Plan Formulary |