COLY MYCIN S OTIC SUSPENSION 3;3.3;10MG/ML;MG/ 5 ML BOTDR (5 ML BOTDR) (NDC: 42023010801)
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)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.94 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$92.00 | $266.00 | None | $39.94 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.91 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
![Email Prescription and/or Health Benefit details for Blue Cross Senior Secure Plan I (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $41.87 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
![Email Prescription and/or Health Benefit details for Blue Cross Senior Secure Plan II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $41.87 |
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)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$40.00 | $80.00 | None | $40.18 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield 65 Plus Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$35.00 | $70.00 | None | $40.18 |
Browse Plan Formulary |
Brand New Day (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Brand |
$40.00 | $80.00 | None | $41.90 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Breathe (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $45.11 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Connect (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$325 |
All Generics, Few Brands |
4 |
Non-Preferred Brand |
25% | 25% | None | $45.11 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore ESRD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $45.11 |
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 |
CareMore Heart (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $45.11 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Reliance (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $45.11 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
![Email Prescription and/or Health Benefit details for CareMore Touch (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $45.11 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
![Email Prescription and/or Health Benefit details for CareMore Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
4 |
Non-Preferred Brand |
$85.00 | $212.50 | None | $41.94 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Medicare Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics |
4 |
Non-Preferred Brand |
$50.00 | $100.00 | None | $41.94 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
25% | 25% | None | $41.94 |
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 |
Easy Choice Best Plan (HMO)
![Email Prescription and/or Health Benefit details for Easy Choice Best Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$90.00 | $180.00 | None | $41.77 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$90.00 | $180.00 | None | $41.80 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Care COPD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$90.00 | $180.00 | None | $41.80 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.81 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.81 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.81 |
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 Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Ruby Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.81 |
Browse Plan Formulary |
Humana Gold Plus H0108-004 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0108-004 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.48 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $50.66 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Basic Fresno (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage Basic Fresno (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $50.29 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, Few Brands |
3 |
Preferred Brand |
$40.00 | $80.00 | None | $50.66 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
![Email Prescription and/or Health Benefit details for StartSmart with CareMore (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $45.11 |
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 |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $50.66 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan North (HMO SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan North (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.60 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $50.46 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.81 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | None | $39.94 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$90 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $41.87 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $41.90 |
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 D SNP (HMO SNP)
![Email Prescription and/or Health Benefit details for Brand New Day D SNP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $41.90 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
![Email Prescription and/or Health Benefit details for Brand New Day HMO Extra Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $41.90 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber I (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | None | $39.81 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | None | $39.81 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Central Health Medi-Medi Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
25% | 25% | None | $41.94 |
Browse Plan Formulary |
Freedom Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
25% | 25% | None | $42.12 |
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 |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for L.A. Care Health Plan Medicare Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $42.12 |
Browse Plan Formulary |
Humana Gold Plus H0108-010 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0108-010 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $39.48 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$92.00 | $266.00 | None | $39.91 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Enhanced Fresno (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage Enhanced Fresno (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$81.00 |
$0 |
All Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $50.29 |
Browse Plan Formulary |