Allopurinol 300mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET in 1 BLISTER PACK (100 BLISTER PACK in 1 BOX ) (NDC: 51079020620)
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 | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $6.61 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $6.60 |
Browse Plan Formulary |
Advantra Elite (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $4.50 | None | $5.04 |
Browse Plan Formulary |
Advantra Preferred (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $4.50 | None | $4.99 |
Browse Plan Formulary |
Advantra Silver (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $4.50 | None | $5.00 |
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)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$7.00 | $14.00 | None | $5.67 |
Browse Plan Formulary |
BlueValue Basic (HMO)
|
$0.00 |
$60* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $6.00 | None | $8.32 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$6.00 | $15.00 | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$6.00 | $15.00 | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $5.14 |
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 | 1 |
Generic |
$6.00 | $15.00 | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $5.14 |
Browse Plan Formulary |
Humana Gold Plus H4141-001 (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 1 |
Preferred Generic |
$3.00 | $0.00 | None | $6.18 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF/DM H4141-009 (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 1 |
Preferred Generic |
$3.00 | $0.00 | None | $6.18 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Basic (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $15.11 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$3.00 | $0.00 | None | $7.59 |
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 | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $7.59 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4141-003 (HMO SNP)
|
$24.80 |
$325* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $6.18 |
Browse Plan Formulary |
Medicare Preferred Core (PPO)
|
$25.00 |
$91* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$5.00 | $7.50 | None | $8.32 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (PPO SNP)
|
$26.30 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $6.60 |
Browse Plan Formulary |
HumanaChoice R5826-077 (Regional PPO)
|
$29.60 |
$150* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $0.00 | None | $6.14 |
Browse Plan Formulary |
Senior Advantage Medicare Medicaid Plan (HMO SNP)
|
$30.20 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $30.00 | None | $15.11 |
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 | 2 |
Tier 2 |
25% | 25% | None | $6.62 |
Browse Plan Formulary |
Advantage by Peach State Health Plan (HMO SNP)
|
$31.00 |
$325* | No additional gap coverage, only the Donut Hole Discount | 1* |
Generic |
$0.00 | $0.00 | None | $5.98 |
Browse Plan Formulary |
Fresenius Health Partners (PPO SNP)
|
$33.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $3.93 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (PPO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $5.14 |
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 | 1 |
Tier 1 |
25% | 25% | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (Regional PPO SNP)
|
$36.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | None | $5.14 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
|
$36.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $5.14 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$45.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$7.00 | $14.00 | None | $5.67 |
Browse Plan Formulary |
HumanaChoice H5214-003 (PPO)
|
$47.00 |
$0 | Few Generics, Few Brands | 1 |
Preferred Generic |
$6.00 | $0.00 | None | $6.18 |
Browse Plan Formulary |
BlueValue Secure (HMO)
|
$48.00 |
$60* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$4.00 | $6.00 | None | $8.32 |
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 | 1* |
Preferred Generic |
$5.00 | $7.50 | None | $8.32 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Enhanced (HMO)
|
$61.00 |
$0 | All Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $15.11 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
|
$64.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $10.00 | None | $4.36 |
Browse Plan Formulary |
Advantra Silver Plus (HMO-POS)
|
$69.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $4.50 | None | $5.05 |
Browse Plan Formulary |
Humana Gold Choice H8145-079 (PFFS)
|
$72.00 |
$0 | Few Generics, Few Brands | 1 |
Preferred Generic |
$5.00 | $0.00 | None | $6.18 |
Browse Plan Formulary |
Today''s Options Premier Plus 650D (PFFS)
|
$92.00 |
$85 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $10.00 | 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 |
Today''s Options Advantage Plus 350A (PPO)
|
$127.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $4.36 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $4.00 | None | $4.36 |
Browse Plan Formulary |