ABILIFY 2MG TABLET (30 BOX) (NDC: 59148000613)
2011 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional 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 Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $1,419.80 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | n/a |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$82.00 | $236.00 | None | n/a |
Browse Plan Formulary |
Advantage Health Florida (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | n/a | Q:31 /31Days | $1,419.00 |
Browse Plan Formulary |
Advantage Silver South (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | n/a | Q:31 /31Days | $1,415.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,424.95 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $220.00 | Q:90 /90Days | n/a |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$65.00 | $130.00 | Q:90 /90Days | n/a |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $60.00 | None | $1,467.13 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$0.00 |
$140 |
to be determined |
3 |
Tier 3 |
$89.00 | $178.00 | S Q:30 /30Days | $1,443.76 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
CareFree Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $260.00 | P Q:30 /30Days | n/a |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | Q:30 /30Days | $1,426.18 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | Q:30 /30Days | $1,422.08 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$89.00 | $267.00 | Q:30 /30Days | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | Q:30 /30Days | $1,426.18 |
Browse Plan Formulary |
Coventry Vista Maximum (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$77.00 | $231.00 | Q:30 /30Days | $1,422.00 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | Q:30 /30Days | $1,422.19 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $120.00 | Q:30 /30Days | $1,426.18 |
Browse Plan Formulary |
e-Any, Any, Any Gold Direct (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $220.00 | Q:90 /90Days | n/a |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P Q:30 /30Days | $1,420.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | P Q:30 /30Days | $1,420.46 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P Q:30 /30Days | $1,420.05 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P Q:30 /30Days | $1,420.05 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P Q:30 /30Days | $1,420.13 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P Q:30 /30Days | $1,420.13 |
Browse Plan Formulary |
Humana Gold Plus H1036-011A (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
Humana Gold Plus H5426-020 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $260.00 | P Q:30 /30Days | n/a |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (PSO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | n/a | Q:60 /30Days | $1,471.13 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Direct (PSO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$20.00 | n/a | Q:60 /30Days | $1,471.13 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (PSO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | n/a | Q:60 /30Days | $1,471.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $150.00 | Q:90 /90Days | $1,433.25 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $200.00 | Q:90 /90Days | $1,441.06 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | Q:90 /90Days | $1,440.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | Q:90 /90Days | $1,435.97 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | Q:90 /90Days | $1,435.97 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Diabetes (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | Q:90 /90Days | $1,435.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece Premier SNP - Institutional (HMO SNP)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:90 /90Days | $1,441.06 |
Browse Plan Formulary |
Molina Medicare Options Miami-Dade & Broward Co. (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | S | $1,423.33 |
Browse Plan Formulary |
Optimum Gold Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P Q:30 /30Days | $1,419.20 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P Q:30 /30Days | $1,419.20 |
Browse Plan Formulary |
POSITIVE HEALTHCARE PARTNERS (HMO SNP)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $1,444.15 |
Browse Plan Formulary |
Preferred Care Partners Preferred Choice Broward (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | S Q:60 /30Days | $1,439.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Preferred Care Partners Preferred Medicare Assist (HMO SNP)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | S Q:60 /30Days | $1,433.31 |
Browse Plan Formulary |
Preferred Care Partners Preferred PremiumAdvantage (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | S Q:60 /30Days | $1,433.21 |
Browse Plan Formulary |
Preferred Care Partners Preferred Special Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | S Q:60 /30Days | $1,433.31 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $240.00 | Q:31 /31Days | $1,418.36 |
Browse Plan Formulary |
PUP Rewards (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | Q:31 /31Days | $1,418.36 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | n/a | None | $1,444.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Value One Florida (HMO SNP)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:31 /31Days | $1,419.00 |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.00 | P Q:31 /31Days | $1,445.44 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.00 | P Q:31 /31Days | $1,459.72 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$13.90 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $200.00 | Q:90 /90Days | $1,438.50 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$16.10 |
$0 |
to be determined |
4 |
Tier 4: Non-Preferred Brand Drugs |
$80.00 | $160.00 | P S Q:1 /1Days | $1,419.60 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /30Days | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WellCare Access (HMO SNP)
|
$20.30 |
$310 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.00 | P Q:31 /31Days | $1,435.74 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$20.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:30 /30Days | $1,320.45 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (PSO SNP)
|
$23.30 |
$310 |
to be determined |
4 |
Tier 4 |
35% | n/a | Q:60 /30Days | $1,471.28 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$23.30 |
$310 |
to be determined |
3 |
Tier 3 |
$89.00 | $222.00 | P Q:31 /31Days | $1,446.96 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$78.00 | $224.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
CareNeeds Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$78.00 | $224.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan IP (PPO SNP)
|
$25.40 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,423.18 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$25.40 |
$310 |
to be determined |
4 |
Tier 4 |
$87.00 | $251.00 | P Q:30 /30Days | $1,318.37 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$25.40 |
$310 |
to be determined |
3 |
Tier 3 |
$95.00 | $285.00 | S | $1,423.88 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /30Days | n/a |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P Q:30 /30Days | $1,320.45 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$31.20 |
$150 |
to be determined |
3 |
Tier 3 |
$89.00 | $178.00 | S Q:30 /30Days | $1,425.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional 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)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4: Non-Preferred Brand Drugs |
$85.00 | $170.00 | P S Q:1 /1Days | $1,419.60 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$39.40 |
$150 |
to be determined |
3 |
Tier 3 |
$89.00 | $178.00 | S Q:30 /30Days | $1,439.14 |
Browse Plan Formulary |