AMOXICILLIN 250MG CAPSULE (12 X 30 PKG) (NDC: 00781202076)
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 Plan 1 (HMO)
|
$0.00 |
$0 |
Some Generics |
2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $8.94 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
Some Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $8.94 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
Some Generics |
1 |
Preferred Generic |
$7.00 | $14.00 | None | $8.82 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$13.00 | $19.50 | None | $18.42 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$13.00 | $19.50 | None | $18.42 |
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 |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$5.00 | $10.00 | None | $10.62 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $10.62 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$5.00 | $10.00 | None | $11.56 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $11.16 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $11.16 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.75 |
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 |
CareMore Connect (HMO SNP)
|
$0.00 |
$325* |
All Generics, Few Brands |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $15.75 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.75 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.75 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.75 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.75 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $15.75 |
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 |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $15.75 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | None | $15.75 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$0.00 | $0.00 | None | $13.36 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $11.72 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $11.61 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $11.61 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $9.68 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $9.68 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $9.68 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $9.68 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.76 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.00 | $16.00 | None | $22.57 |
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 |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $22.63 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | n/a | None | $11.16 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.76 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $16.76 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $16.76 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $15.75 |
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 |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $22.57 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$23.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $9.68 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $8.94 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$28.00 |
$90 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$14.00 | $21.00 | None | $18.42 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $11.56 |
Browse Plan Formulary |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $11.56 |
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 |
Brand New Day HMO Extra Care (HMO)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $11.56 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325 |
Few Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $11.16 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $9.68 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $9.67 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$29.80 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Generic |
$0.00 | $0.00 | None | $10.04 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | None | $15.75 |
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 |
Freedom Plan (HMO SNP)
|
$29.90 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $11.32 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $11.32 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $16.76 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $16.76 |
Browse Plan Formulary |
Easy Choice Pacific Plan (HMO)
|
$94.30 |
$325* |
Many Generics |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $11.65 |
Browse Plan Formulary |
Health Net Ruby Select (HMO)
|
$119.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $9.68 |
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 |
Health Net Seniority Plus Ruby (HMO)
|
$182.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $9.63 |
Browse Plan Formulary |