AMLODIPINE BESYLATE 5MG TABLET (90 CT) (90 BOT) (NDC: 65862010290)
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)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $5.02 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $5.02 |
Browse Plan Formulary |
Advantra Elite (HMO)
![Email Prescription and/or Health Benefit details for Advantra Elite (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $4.50 | None | $7.05 |
Browse Plan Formulary |
Advantra Preferred (PPO)
![Email Prescription and/or Health Benefit details for Advantra Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $4.50 | None | $7.00 |
Browse Plan Formulary |
Advantra Silver (HMO-POS)
![Email Prescription and/or Health Benefit details for Advantra Silver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $4.50 | None | $7.00 |
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 |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $14.00 | Q:1 /1Days | $7.01 |
Browse Plan Formulary |
BlueValue Basic (HMO)
![Email Prescription and/or Health Benefit details for BlueValue Basic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$60* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$4.00 | $6.00 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Copper RX (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$6.00 | $15.00 | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (Regional PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Copper RX (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$8.00 | $20.00 | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Gold Rx (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$6.00 | $15.00 | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Gold Rx (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$8.00 | $20.00 | None | $8.67 |
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)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Medicare Advantage (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$6.00 | $15.00 | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Medicare Advantage (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$8.00 | $20.00 | None | $8.67 |
Browse Plan Formulary |
Humana Gold Plus H4141-001 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4141-001 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$3.00 | $0.00 | None | $5.22 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF/DM H4141-009 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-CVD/CHF/DM H4141-009 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
1 |
Preferred Generic |
$3.00 | $0.00 | None | $5.22 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Basic (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage Basic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, Few Brands |
1 |
Preferred Generic |
$7.00 | $14.00 | None | $23.55 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$3.00 | $0.00 | None | $4.36 |
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 |
WellCare Access (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Access (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.90 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $4.36 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4141-003 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H4141-003 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.80 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.22 |
Browse Plan Formulary |
Medicare Preferred Core (PPO)
![Email Prescription and/or Health Benefit details for Medicare Preferred Core (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$91* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | $7.50 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.30 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $5.01 |
Browse Plan Formulary |
HumanaChoice R5826-077 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-077 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.60 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$4.00 | $0.00 | None | $5.19 |
Browse Plan Formulary |
Senior Advantage Medicare Medicaid Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medicaid Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $23.55 |
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 |
UnitedHealthcare Nursing Home Plan (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $5.02 |
Browse Plan Formulary |
Advantage by Peach State Health Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Advantage by Peach State Health Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.88 |
Browse Plan Formulary |
Fresenius Health Partners (PPO SNP)
![Email Prescription and/or Health Benefit details for Fresenius Health Partners (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $5.17 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Chrome RX (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Dual Advantage (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Silver Rx (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $8.67 |
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)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Silver Rx (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.30 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (Regional PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Chrome RX (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $8.67 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
![Email Prescription and/or Health Benefit details for Care Improvement Plus Dual Advantage (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $8.67 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $14.00 | Q:1 /1Days | $7.01 |
Browse Plan Formulary |
HumanaChoice H5214-003 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5214-003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$6.00 | $0.00 | None | $5.22 |
Browse Plan Formulary |
BlueValue Secure (HMO)
![Email Prescription and/or Health Benefit details for BlueValue Secure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.00 |
$60* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$4.00 | $6.00 | Q:45 /30Days | $24.64 |
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)
![Email Prescription and/or Health Benefit details for Medicare Preferred Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.00 |
$91* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$5.00 | $7.50 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Enhanced (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage Enhanced (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$61.00 |
$0 |
All Generics, Few Brands |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $23.55 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
![Email Prescription and/or Health Benefit details for Today''s Options Advantage Plus 650B (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$64.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $7.20 |
Browse Plan Formulary |
Advantra Silver Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Advantra Silver Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $4.50 | None | $7.06 |
Browse Plan Formulary |
Humana Gold Choice H8145-079 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-079 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$72.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$5.00 | $0.00 | None | $5.23 |
Browse Plan Formulary |
Today''s Options Premier Plus 650D (PFFS)
![Email Prescription and/or Health Benefit details for Today''s Options Premier Plus 650D (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$92.00 |
$85 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $7.20 |
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)
![Email Prescription and/or Health Benefit details for Today''s Options Advantage Plus 350A (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$127.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $4.00 | None | $7.20 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
![Email Prescription and/or Health Benefit details for Today''s Options Premier Plus 350A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$152.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $4.00 | None | $7.20 |
Browse Plan Formulary |