NIMODIPINE 30MG CAPSULE (100 BLPK) (NDC: 00555098040)
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 |
5 |
Tier 5 |
33% | 33% | None | $2,687.06 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,683.65 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,683.65 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$33.00 | $66.00 | None | $2,500.83 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $220.00 | None | $2,000.67 |
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 | $1,699.90 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | None | $3,208.05 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | None | $3,208.05 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | None | $3,208.05 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
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 Summit Select (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $125.00 | None | $3,208.05 |
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 | None | $3,208.05 |
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 | None | $3,259.17 |
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 (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 |
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 |
4 |
Tier 4 |
$60.00 | $150.00 | None | $2,000.67 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $200.00 | None | $2,000.67 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $2,000.67 |
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 - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $2,000.67 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $125.00 | None | $2,000.67 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $2,131.00 |
Browse Plan Formulary |
Preferred Choice Broward (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | None | $2,696.12 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$55.00 | $110.00 | None | $2,696.12 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | None | $2,696.12 |
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 Select Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | None | $2,696.12 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,683.65 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,662.26 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $2,536.19 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$0.00 |
$320 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,694.84 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $7.50 | None | $2,689.57 |
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 |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,705.98 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$1.10 |
$320 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $2,131.00 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$6.10 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$18.10 |
$320 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $2,740.33 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$19.20 |
$320 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | None | $2,749.94 |
Browse Plan Formulary |
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 |
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 Summit Maximum (HMO SNP)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
|
$21.60 |
$320 |
to be determined |
4 |
Tier 4 |
$93.00 | $269.00 | None | $3,208.05 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$22.90 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $3,208.05 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,131.00 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $3,208.05 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $3,208.05 |
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 |
Coventry Vista Maximum (HMO SNP)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $2,616.83 |
Browse Plan Formulary |
MediMax (HMO)
|
$23.80 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $2,582.20 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$79.00 | $200.00 | None | $2,000.67 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $245.00 | None | $3,259.17 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$39.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $3,308.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$68.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $2,385.56 |
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 |
Humana Gold Choice H8145-061 (PFFS)
|
$99.00 |
$0 |
to be determined |
3 |
Tier 3 |
$81.00 | $233.00 | None | $3,304.64 |
Browse Plan Formulary |
HumanaChoice H5415-068 (PPO)
|
$149.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $3,208.05 |
Browse Plan Formulary |