FELBAMATE 400 MG TABLET (30 EA ) (NDC: 65162073403)
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 Plan 2 (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $800.84 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $800.84 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $800.84 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$33.00 | $66.00 | None | $801.05 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | None | $760.81 |
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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $758.11 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $720.16 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | $110.00 | None | $1,028.58 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $65.00 | None | $1,028.58 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $764.06 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $764.06 |
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 |
1 |
Tier 1 |
$0.00 | $0.00 | None | $764.06 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $745.01 |
Browse Plan Formulary |
Healthy Advantage Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $703.67 |
Browse Plan Formulary |
Healthy Advantage Refund (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $703.67 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$25.00 | $65.00 | None | $1,028.58 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$40.00 | $110.00 | None | $1,028.58 |
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 Reader's Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | None | $1,038.84 |
Browse Plan Formulary |
JacksonHealth for Life (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $747.16 |
Browse Plan Formulary |
JacksonHealth Secure (HMO SNP)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $747.16 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | n/a | None | n/a |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (PSO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | n/a | None | n/a |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Chronic Care (PSO SNP)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | n/a | None | 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 |
Medica HealthCare Plans MedicareMax Value RX (PSO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | n/a | None | n/a |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $760.81 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $760.81 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $760.81 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $760.81 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $815.96 |
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 |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$320 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Preferred Choice Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $756.76 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $756.76 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | None | $756.76 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $756.76 |
Browse Plan Formulary |
Preferred Premium Advantage Miami-Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $756.76 |
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 |
Preferred Special Care Miami-Dade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $756.76 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $800.84 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $800.84 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $711.70 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $711.70 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $711.70 |
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 |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $745.01 |
Browse Plan Formulary |
WellCare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $776.27 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $776.27 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$1.10 |
$320* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $815.96 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$6.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $764.06 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$18.10 |
$320 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $776.27 |
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 |
Medica HealthCare Plans MedicareMax Plus (PSO SNP)
|
$19.40 |
$320* |
to be determined |
1* |
Tier 1 |
$0.00 | n/a | None | n/a |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $764.06 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$22.60 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $1,028.58 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$23.80 |
$320 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $803.84 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$87.00 | $251.00 | None | $1,028.58 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$87.00 | $251.00 | None | $1,028.58 |
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 Maximum (HMO SNP)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $764.06 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $1,028.58 |
Browse Plan Formulary |
Medicare Masterpiece Premier SNP - Dual (HMO SNP)
|
$23.80 |
$320 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $760.81 |
Browse Plan Formulary |
MediMax (HMO)
|
$23.80 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $745.01 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$23.80 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $742.52 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$23.80 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $742.52 |
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 |
Simply Complete (HMO SNP)
|
$23.80 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $711.70 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $776.27 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | None | $760.81 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | None | $1,038.84 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$39.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,028.58 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$68.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $801.05 |
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 Choice H8145-061 (PFFS)
|
$99.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | None | $1,038.84 |
Browse Plan Formulary |