HECTOROL 2.5MCG CAPSULE (NDC: 58468012101)
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 |
3 |
Tier 3 |
$45.00 | $125.00 | P | $1,074.95 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | P | $1,074.52 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | P | $1,074.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | P | $1,075.52 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,076.34 |
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 |
CareFree PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$24.00 | $62.00 | P | $1,067.13 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | P | $1,067.13 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $75.00 | P | $1,078.26 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $180.00 | P | $1,078.26 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $60.00 | P | $1,078.26 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,076.95 |
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 Care (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,077.01 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,077.01 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,077.01 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,077.01 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | P | $1,067.13 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$24.00 | $62.00 | P | $1,067.13 |
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 |
2 |
Tier 2 |
$41.00 | $113.00 | P | $1,063.39 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | P | $1,082.70 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (PSO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$10.00 | n/a | None | n/a |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Chronic Care (PSO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | n/a | None | n/a |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (PSO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | n/a | None | n/a |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $75.00 | P | $1,078.51 |
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 - COPD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | $1,074.76 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | $1,074.80 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | P | $1,074.80 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,082.33 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,082.33 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$320 |
to be determined |
2 |
Tier 2 |
25% | n/a | P | 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 |
Preferred Choice Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $1,086.35 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $1,086.35 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$55.00 | $110.00 | P | $1,086.29 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | P | $1,086.41 |
Browse Plan Formulary |
Preferred Premium Advantage Miami-Dade (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | P | $1,086.35 |
Browse Plan Formulary |
Preferred Special Care Miami-Dade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $1,086.35 |
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 EASY (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | P | $1,074.52 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $110.00 | P | $1,074.40 |
Browse Plan Formulary |
WellCare Choice (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P | $1,079.59 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $62.50 | P | $1,079.59 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$6.10 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | P | $1,077.79 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$18.10 |
$320 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $1,089.26 |
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 |
3 |
Tier 3 |
35% | n/a | None | n/a |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | P | $1,078.24 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$22.60 |
$320 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | P | $1,067.13 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$23.80 |
$320 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,062.84 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
$43.00 | $119.00 | P | $1,067.13 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
$44.00 | $122.00 | P | $1,067.13 |
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 |
3 |
Tier 3 |
$76.00 | $228.00 | P | $1,078.24 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | P | $1,067.13 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$23.80 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P | $1,079.59 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $110.00 | P | $1,075.00 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$34.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $110.00 | P | $1,063.39 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$39.00 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $119.00 | P | $1,066.62 |
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 |
2 |
Tier 2 |
$42.00 | $116.00 | P | $1,063.35 |
Browse Plan Formulary |