TRAMADOL HYDROCHLORIDE 100mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC (30 TABLET, EXTENDED RELEA ) (NDC: 49884082111)
2013 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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $83.11 |
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 |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$6.00 | $12.00 | Q:30 /30Days | $68.32 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
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 |
HealthPlus MedicarePlus-Advantage D-SNP (HMO SNP)
|
$23.60 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $68.39 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$9.00 | $22.50 | None | $72.18 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
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 Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
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 |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 1 (HMO-POS)
|
$79.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $14.00 | Q:30 /30Days | $68.32 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$89.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $72.18 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $72.18 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $83.11 |
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 Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS)
|
$125.00 |
$0 | All Generics | 1 |
Generic |
$6.00 | $12.00 | Q:30 /30Days | $68.32 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantagePPO Enhanced (PPO)
|
$136.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$6.00 | $12.00 | Q:30 /30Days | $68.46 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $83.11 |
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 Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $83.11 |
Browse Plan Formulary |