Vivelle Dot 0.0375mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 (3 PACKET in 1 CARTON / 8 ) (NDC: 00078034345)
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 | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $229.65 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $233.42 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $227.68 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $230.81 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $230.01 |
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 Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $229.65 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $229.53 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $229.00 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $230.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $230.61 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$20.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | P Q:8 /28Days | $227.66 |
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 |
PriorityMedicare Value (HMO-POS)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | None | $229.22 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$37.50 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | P Q:8 /28Days | $227.66 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $230.61 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $230.55 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $229.00 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $229.53 |
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)
|
$41.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:8 /28Days | $229.65 |
Browse Plan Formulary |
HumanaChoice H5470-005 (PPO)
|
$62.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$90.00 | $260.00 | P Q:8 /28Days | $226.96 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$72.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | P Q:8 /28Days | $227.26 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $229.65 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $233.42 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $227.68 |
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 Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $230.81 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $230.01 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$89.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$35.00 | $87.50 | None | $229.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:8 /28Days | $229.65 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:8 /28Days | $230.61 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:8 /28Days | $230.55 |
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)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:8 /28Days | $229.00 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$96.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:8 /28Days | $229.53 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | None | $229.13 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $227.99 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $228.12 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $229.00 |
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)
|
$151.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $228.48 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$151.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | Q:8 /28Days | $229.16 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:8 /28Days | $230.01 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:8 /28Days | $230.81 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:8 /28Days | $227.68 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:8 /28Days | $233.42 |
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)
|
$203.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | Q:8 /28Days | $229.65 |
Browse Plan Formulary |