ALINIA 500MG TABLET (60 BOT) (NDC: 67546011111)
2012 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 (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$92.00 | $266.00 | None | $1,314.06 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $1,314.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$92.00 | $266.00 | None | $1,314.21 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | None | $1,243.58 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $255.00 | None | $1,301.28 |
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 |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:40 /30Days | $1,226.28 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:40 /30Days | $1,226.28 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | Q:40 /30Days | $1,229.44 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:40 /30Days | $1,226.28 |
Browse Plan Formulary |
Citrus Total (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $230.00 | None | $1,314.02 |
Browse Plan Formulary |
Coventry Advantra Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $180.00 | None | $1,246.45 |
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 Advantra Select Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $237.00 | None | $1,247.05 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,324.31 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | Q:6 /3Days | $1,324.01 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,325.29 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,325.29 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,325.29 |
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 VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,325.29 |
Browse Plan Formulary |
Humana Gold Plus H1036-025 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:40 /30Days | $1,220.58 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:40 /30Days | $1,227.98 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-160 (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $155.00 | Q:40 /30Days | $1,227.60 |
Browse Plan Formulary |
Humana Reader's Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | Q:40 /30Days | $1,230.04 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $110.00 | None | $1,243.76 |
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 (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | None | $1,244.49 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,244.38 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,244.40 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,244.40 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | None | $1,243.79 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:12 /30Days | $1,301.56 |
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 |
Optimum Diamond Rewards (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,326.70 |
Browse Plan Formulary |
Optimum Diamond Rewards COPD (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,326.70 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,326.44 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:6 /3Days | $1,326.44 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$55.00 | $110.00 | Q:6 /30Days | $1,254.47 |
Browse Plan Formulary |
Preferred Select Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | Q:6 /30Days | $1,254.68 |
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 |
PUP PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $285.00 | None | $1,312.47 |
Browse Plan Formulary |
PUP SIMPLE (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $240.00 | None | $1,312.47 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$0.00 |
$320 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,314.16 |
Browse Plan Formulary |
Universal Hassle-Free (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | None | $1,243.43 |
Browse Plan Formulary |
WellCare Choice (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $172.50 | P | $1,243.55 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,246.70 |
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 Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $172.50 | P | $1,247.31 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$1.10 |
$320 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:12 /30Days | $1,301.56 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,313.71 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$12.40 |
$320 |
to be determined |
2 |
Tier 2 |
n/a | n/a | Q:6 /3Days | $1,324.23 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$16.10 |
$320 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:6 /3Days | $1,324.23 |
Browse Plan Formulary |
Coventry Advantra Maximum (HMO SNP)
|
$17.70 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | None | $1,246.56 |
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 Medi-Medi Partial (HMO SNP)
|
$18.10 |
$320 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:6 /3Days | $1,324.27 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$18.10 |
$320 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | P | $1,248.14 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO SNP)
|
$18.20 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:40 /30Days | $1,227.98 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$19.20 |
$320 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | P | $1,248.71 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-161 (HMO SNP)
|
$20.00 |
$320 |
to be determined |
4 |
Tier 4 |
$87.00 | $251.00 | Q:40 /30Days | $1,227.98 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$23.20 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:40 /30Days | $1,227.60 |
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 Specialty + Rx (HMO SNP)
|
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:12 /30Days | $1,301.74 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | Q:40 /30Days | $1,229.44 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$23.80 |
$320 |
to be determined |
2 |
Tier 2 |
n/a | n/a | Q:6 /3Days | $1,324.27 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $110.00 | None | $1,244.31 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | Q:40 /30Days | $1,230.04 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$38.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | Q:6 /3Days | $1,307.08 |
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 Premier Plan (PPO)
|
$68.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | Q:6 /3Days | $1,304.95 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$99.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | Q:40 /30Days | $1,229.81 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$150.00 |
$105 |
to be determined |
3 |
Tier 3 |
$95.00 | $285.00 | None | $1,302.69 |
Browse Plan Formulary |