Actonel 30mg/1 12 BOTTLE CASE / 30 FILM COATED TABLETS in BOTTLE (12 BOTTLE in 1 CASE / 30 ) (NDC: 00430047015)
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 | 3 |
Preferred Brand |
$42.00 | $116.00 | None | $1,111.87 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $1,111.87 |
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 | S Q:30 /30Days | $1,142.70 |
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 | S Q:30 /30Days | $1,138.16 |
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 | S Q:30 /30Days | $1,138.41 |
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 |
BlueValue Basic (HMO)
|
$0.00 |
$60 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:30 /30Days | $1,177.49 |
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 | $1,132.40 |
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 | $1,130.97 |
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 | $1,132.40 |
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 | $1,130.97 |
Browse Plan Formulary |
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 | $1,132.40 |
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 (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $1,130.97 |
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 | $1,140.77 |
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 | $1,140.77 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Basic (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 4 |
Non-Preferred Brand |
$75.00 | $150.00 | None | $1,168.08 |
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 | $1,140.77 |
Browse Plan Formulary |
Medicare Preferred Core (PPO)
|
$25.00 |
$91 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$93.00 | $232.50 | S Q:30 /30Days | $1,177.49 |
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 Dual Complete (PPO SNP)
|
$26.30 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | None | $1,111.64 |
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 | $1,136.79 |
Browse Plan Formulary |
Senior Advantage Medicare Medicaid Plan (HMO SNP)
|
$30.20 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$75.00 | $150.00 | None | $1,168.08 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$30.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $1,113.59 |
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 | $1,126.40 |
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 | $1,132.40 |
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 (PPO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | None | $1,132.40 |
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 | $1,132.40 |
Browse Plan Formulary |
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 | $1,130.97 |
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 | $1,130.97 |
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 | $1,130.97 |
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 | $1,137.67 |
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 |
BlueValue Secure (HMO)
|
$48.00 |
$60 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:30 /30Days | $1,177.49 |
Browse Plan Formulary |
Medicare Preferred Premier (PPO)
|
$60.00 |
$91 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$93.00 | $232.50 | S Q:30 /30Days | $1,177.49 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Enhanced (HMO)
|
$61.00 |
$0 | All Generics, Few Brands | 4 |
Non-Preferred Brand |
$75.00 | $150.00 | None | $1,168.08 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
|
$64.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $1,116.81 |
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 | S Q:30 /30Days | $1,142.70 |
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 | $1,136.91 |
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 Premier Plus 650D (PFFS)
|
$92.00 |
$85 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $1,117.77 |
Browse Plan Formulary |
Today''s Options Advantage Plus 350A (PPO)
|
$127.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $1,116.81 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $160.00 | None | $1,117.77 |
Browse Plan Formulary |