AGGRENOX 25-200MG CAPSULE (60 BOT) (NDC: 00597000160)
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 SecureHorizons (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $272.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:2 /1Days | $277.27 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $277.18 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $277.04 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $277.18 |
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 Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $277.04 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $277.18 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $277.04 |
Browse Plan Formulary |
Care N'' Care Health Plan III (PPO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $120.00 | None | $285.90 |
Browse Plan Formulary |
HealthSpring Achieve (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:60 /30Days | $274.37 |
Browse Plan Formulary |
HealthSpring Preferred (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:60 /30Days | $274.16 |
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 Plus H4510-018 (HMO)
|
$0.00 |
$125 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $245.00 | S | $274.84 |
Browse Plan Formulary |
TexanPlus Classic (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $273.75 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$22.60 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | None | $272.92 |
Browse Plan Formulary |
Care N'' Care Health Plan II (PPO)
|
$29.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$36.00 | $108.00 | None | $285.90 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$29.00 |
$125 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$89.00 | $257.00 | S | $274.97 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$29.10 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $272.93 |
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 |
Advantage by Superior HealthPlan (HMO SNP)
|
$30.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $45.00 | Q:60 /30Days | $275.38 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.90 |
$325 | Many Generics, Few Brands | 3 |
Non-Preferred Brand |
$95.00 | $285.00 | None | $271.14 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-023 (HMO SNP)
|
$31.70 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | S | $274.83 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $277.18 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (Regional PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $277.04 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | None | $277.18 |
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)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | None | $277.04 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $277.18 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional PPO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $277.04 |
Browse Plan Formulary |
HealthSpring TotalCare (HMO SNP)
|
$31.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:60 /30Days | $274.16 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
|
$32.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $273.82 |
Browse Plan Formulary |
HealthSpring Preferred (PPO)
|
$35.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$30.00 | $80.00 | Q:60 /30Days | $273.70 |
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 |
Erickson Advantage Freedom (HMO-POS)
|
$48.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $273.07 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$56.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:2 /1Days | $277.27 |
Browse Plan Formulary |
Humana Prime Choice H4520-006 (PPO)
|
$57.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$83.00 | $239.00 | S | $274.94 |
Browse Plan Formulary |
Today''s Options Premier Plus 650B (PFFS)
|
$66.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $273.88 |
Browse Plan Formulary |
Blue Medicare Advantage (PPO)
|
$69.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $274.82 |
Browse Plan Formulary |
Care N'' Care Health Plan I (PPO)
|
$75.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$33.00 | $99.00 | None | $285.90 |
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 H8145-084 (PFFS)
|
$87.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$80.00 | $230.00 | S | $275.01 |
Browse Plan Formulary |
Today''s Options Advantage Plus 350A (PPO)
|
$107.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $273.82 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$122.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $273.88 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $110.00 | None | $273.07 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$176.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $110.00 | None | $273.07 |
Browse Plan Formulary |