Atripla 600; 200; 300mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (30 TABLET, FILM COATED in ) (NDC: 15584010101)
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 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,799.23 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,799.16 |
Browse Plan Formulary |
Anthem Medicare Preferred Core (PPO)
|
$0.00 |
$60* |
to be determined |
5* |
Tier 5 |
33% | n/a | None | $1,872.30 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,803.64 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,806.31 |
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 Total Care (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $1,803.71 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $102.00 | None | $1,828.64 |
Browse Plan Formulary |
Gold Advantage Option 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $1,805.34 |
Browse Plan Formulary |
Gold Advantage Option II (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $1,804.06 |
Browse Plan Formulary |
Humana Gold Plus H2649-023 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,794.35 |
Browse Plan Formulary |
Universal Hassle-Free (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,802.50 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,811.36 |
Browse Plan Formulary |
Advantra (PPO)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $1,804.06 |
Browse Plan Formulary |
Advantra Option 1 (HMO)
|
$27.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $1,805.11 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$28.10 |
$320 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,811.36 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,782.65 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,781.66 |
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 |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,781.02 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,880.75 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,781.74 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,780.53 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,781.22 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,780.34 |
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 |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,783.49 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,760.18 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,787.50 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
5 |
Tier 5 |
29% | 29% | None | $1,781.36 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$28.90 |
$215 |
to be determined |
4 |
Tier 4 |
27% | 27% | None | $1,806.31 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional PPO SNP)
|
$31.80 |
$150 |
to be determined |
4 |
Tier 4 |
29% | 29% | None | $1,806.31 |
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 |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
|
$31.90 |
$240 |
to be determined |
4 |
Tier 4 |
27% | 27% | None | $1,806.31 |
Browse Plan Formulary |
Humana Gold Choice H8145-125 (PFFS)
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,793.01 |
Browse Plan Formulary |
HumanaChoice R5826-010 (Regional PPO)
|
$35.20 |
$320 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,798.52 |
Browse Plan Formulary |
HumanaChoice H1716-020 (PPO)
|
$39.00 |
$320 |
to be determined |
4 |
Tier 4 |
30% | 30% | None | $1,794.53 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$42.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $1,799.22 |
Browse Plan Formulary |
Essence Advantage Plus (HMO)
|
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$29.00 | $87.00 | None | $1,828.64 |
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 |
WindsorSterling Gold Plus Plan (PPO)
|
$50.00 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,780.54 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,760.18 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,787.50 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,781.02 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,782.65 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,781.66 |
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 |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,780.53 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,880.75 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,781.74 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,781.39 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,781.22 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,780.34 |
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 |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,783.49 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
5 |
Tier 5 |
30% | 30% | None | $1,781.36 |
Browse Plan Formulary |
HumanaChoice H1716-006 (PPO)
|
$73.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,794.51 |
Browse Plan Formulary |
Advantra Option 2 (HMO-POS)
|
$88.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $1,805.11 |
Browse Plan Formulary |