ABILIFY 15MG TABLET (30 BOT) (NDC: 59148000913)
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 |
AARP MedicareComplete (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $687.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $687.36 |
Browse Plan Formulary |
Advantra Elite (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:30 /30Days | $694.09 |
Browse Plan Formulary |
Advantra Preferred (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:30 /30Days | $692.73 |
Browse Plan Formulary |
Advantra Silver (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:30 /30Days | $693.06 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | Q:1 /1Days | $694.06 |
Browse Plan Formulary |
BlueValue Basic (HMO)
|
$0.00 |
$60 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days | $727.12 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $697.36 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $697.51 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $697.36 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $697.51 |
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 |
Care Improvement Plus Medicare Advantage (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $697.36 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $697.51 |
Browse Plan Formulary |
Humana Gold Plus H4141-001 (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 4 |
Non-Preferred Brand |
$92.00 | $266.00 | Q:30 /30Days | $706.83 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF/DM H4141-009 (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $706.83 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Basic (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 3 |
Preferred Brand |
$44.00 | $88.00 | None | $737.56 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$75.00 | $150.00 | Q:31 /31Days | $704.71 |
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 Access (HMO SNP)
|
$17.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $190.00 | Q:31 /31Days | $704.71 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4141-003 (HMO SNP)
|
$24.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$92.00 | $266.00 | Q:30 /30Days | $706.83 |
Browse Plan Formulary |
Medicare Preferred Core (PPO)
|
$25.00 |
$91 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days | $727.12 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (PPO SNP)
|
$26.30 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
15% | 15% | None | $687.25 |
Browse Plan Formulary |
HumanaChoice R5826-077 (Regional PPO)
|
$29.60 |
$150 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | Q:30 /30Days | $698.19 |
Browse Plan Formulary |
Senior Advantage Medicare Medicaid Plan (HMO SNP)
|
$30.20 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$44.00 | $88.00 | None | $737.56 |
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 |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$30.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $687.66 |
Browse Plan Formulary |
Advantage by Peach State Health Plan (HMO SNP)
|
$31.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $45.00 | Q:30 /30Days | $695.47 |
Browse Plan Formulary |
Fresenius Health Partners (PPO SNP)
|
$33.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | Q:30 /30Days | $688.03 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (PPO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $697.36 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | None | $697.36 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $697.36 |
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 Silver Rx (Regional PPO SNP)
|
$36.30 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $697.51 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (Regional PPO SNP)
|
$36.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $697.51 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
|
$36.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | None | $697.51 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$45.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | Q:1 /1Days | $691.53 |
Browse Plan Formulary |
HumanaChoice H5214-003 (PPO)
|
$47.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | Q:30 /30Days | $706.12 |
Browse Plan Formulary |
BlueValue Secure (HMO)
|
$48.00 |
$60 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days | $727.12 |
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 |
Medicare Preferred Premier (PPO)
|
$60.00 |
$91 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | Q:60 /30Days | $727.12 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Enhanced (HMO)
|
$61.00 |
$0 | All Generics, Few Brands | 3 |
Preferred Brand |
$44.00 | $88.00 | None | $737.56 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
|
$64.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | None | $689.34 |
Browse Plan Formulary |
Advantra Silver Plus (HMO-POS)
|
$69.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$85.00 | $212.50 | Q:30 /30Days | $696.38 |
Browse Plan Formulary |
Humana Gold Choice H8145-079 (PFFS)
|
$72.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$90.00 | $260.00 | Q:30 /30Days | $705.75 |
Browse Plan Formulary |
Today''s Options Premier Plus 650D (PFFS)
|
$92.00 |
$85 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | None | $689.85 |
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 |
Today''s Options Advantage Plus 350A (PPO)
|
$127.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $80.00 | None | $689.34 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $80.00 | None | $689.85 |
Browse Plan Formulary |