COLCRYS 0.6 MG TABLET (100 EA ) (NDC: 64764011901)
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 Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $305.38 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $305.22 |
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 | $305.22 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:4 /1Days | $306.78 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$35.00 | $70.00 | Q:60 /30Days | $305.46 |
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 |
BlueMedicare HMO (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Preferred Brand |
$45.00 | $135.00 | None | $306.17 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | None | $305.95 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days | $315.44 |
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 |
Coventry Summit Ideal (HMO-POS)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$25.00 | $50.00 | Q:120 /30Days | $320.51 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$35.00 | $70.00 | Q:120 /30Days | $322.69 |
Browse Plan Formulary |
Coventry Summit Select (HMO-POS)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$30.00 | $60.00 | Q:120 /30Days | $327.09 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$20.00 | $40.00 | Q:120 /30Days | $327.05 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | None | $298.17 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$65.00 | $130.00 | None | $298.16 |
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 |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | None | $298.11 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | None | $298.11 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | None | $298.11 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | None | $298.11 |
Browse Plan Formulary |
Humana Gold Plus H1036-062C (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
Humana Gold Plus H1036-199 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:120 /30Days | $305.60 |
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 SNP-CVD/CHF H1036-190 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-130C (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:120 /30Days | $305.17 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$75.00 | $150.00 | None | $298.52 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$5.00 | $10.00 | Q:62 /31Days | $305.34 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$15.00 | $25.00 | Q:62 /31Days | $305.26 |
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 |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$40.00 | $120.00 | Q:120 /30Days | $315.44 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Preferred Brand |
$20.00 | $40.00 | None | $311.24 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$25.00 | $50.00 | None | $310.16 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 | to be determined | 2 |
Tier 2 |
$0.00 | $0.00 | Q:62 /31Days | $305.40 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | Q:120 /30Days | $315.44 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $310.70 |
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 |
WellCare Liberty (HMO SNP)
|
$8.70 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $310.89 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.10 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $310.89 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-104A (HMO SNP)
|
$16.50 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $303.89 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-152 (HMO SNP)
|
$22.30 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$23.10 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | None | $298.21 |
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)
|
$23.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $305.46 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $45.00 | None | $309.19 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 | Some Generics | 3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | $305.46 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $298.21 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | Q:120 /30Days | $305.60 |
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 |
Optimum Emerald Full (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | None | $298.19 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $298.19 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | None | $305.38 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$25.50 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:120 /30Days | $325.48 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $110.00 | Q:120 /30Days | $305.17 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$33.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | Q:4 /1Days | $307.26 |
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 |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 | Few Generics, Few Brands | 2 |
Preferred Brand |
$43.00 | $119.00 | Q:120 /30Days | $304.92 |
Browse Plan Formulary |
Day Break (HMO)
|
$68.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$60.00 | $180.00 | Q:120 /30Days | $315.44 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:120 /30Days | $305.15 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | None | $306.17 |
Browse Plan Formulary |
HumanaChoice H5415-067 (PPO)
|
$152.00 |
$0 | Few Generics, Few Brands | 2 |
Preferred Brand |
$40.00 | $110.00 | Q:120 /30Days | $305.60 |
Browse Plan Formulary |