DEMECLOCYCLINE HCL 150MG TABLET (100 BOT) (NDC: 00555070102)
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 | $341.79 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$30.00 | $80.00 | None | $334.51 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$30.00 | $80.00 | None | $334.51 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | P | $552.49 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $512.76 |
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 |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $576.27 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $15.00 | None | $567.75 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$10.00 | $20.00 | None | $599.15 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$20.00 | $50.00 | None | $599.15 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$10.00 | $20.00 | None | $599.15 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$7.00 | $11.00 | None | $599.15 |
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 |
Clear Skies (HMO SNP)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $206.25 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$40.00 | $120.00 | None | $832.44 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$70.00 | $210.00 | None | $835.89 |
Browse Plan Formulary |
Coventry Summit Select (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$70.00 | $210.00 | None | $904.14 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$75.00 | $225.00 | None | $901.73 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$50.00 | $150.00 | None | $903.84 |
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 H1036-065C (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$7.00 | $11.00 | None | $599.15 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$10.00 | $20.00 | None | $599.15 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$10.00 | $20.00 | None | $599.15 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $599.15 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$0.00 | n/a | None | $581.75 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$0.00 | n/a | None | $581.75 |
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 |
PUP EASY (HMO)
|
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$45.00 | $115.00 | None | $333.93 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $270.00 | None | $333.05 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$60.00 | n/a | None | $789.49 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$30.00 | n/a | None | $789.49 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$30.00 | n/a | None | $789.49 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$40.00 | n/a | None | $789.49 |
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 |
Sunrise (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $206.25 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$3.00 | $0.00 | None | $899.22 |
Browse Plan Formulary |
WellCare Essential (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $900.21 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$0.00 | $0.00 | None | $901.29 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | None | $347.58 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $206.25 |
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 Select (HMO-POS SNP)
|
$8.50 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $901.82 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$8.70 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $902.13 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.10 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $902.13 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$12.20 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | None | $599.15 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$18.20 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | None | $899.39 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-185 (HMO SNP)
|
$20.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $599.15 |
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-DE H1036-162 (HMO SNP)
|
$20.60 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | None | $599.15 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.20 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | None | $599.15 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO SNP)
|
$23.40 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | n/a | None | $581.75 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$23.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $345.60 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $998.60 |
Browse Plan Formulary |
Coventry Vista Maximum (HMO SNP)
|
$24.70 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | None | $899.39 |
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 |
CareNeeds (HMO SNP)
|
$24.80 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | None | $599.15 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$24.80 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$25.00 | n/a | None | $789.49 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$24.80 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$25.00 | n/a | None | $789.49 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$24.80 |
$0 |
to be determined |
4 |
Tier 4 |
$75.00 | n/a | None | $789.49 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $341.79 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | None | $902.21 |
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 |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | None | $599.15 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | P | $525.91 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 |
Few Generics, Few Brands |
3 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $599.15 |
Browse Plan Formulary |
Day Break (HMO)
|
$68.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $206.25 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $599.15 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$17.00 | $24.00 | None | $581.91 |
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 |
HumanaChoice H5415-068 (PPO)
|
$152.00 |
$0 |
Few Generics, Few Brands |
3 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $599.15 |
Browse Plan Formulary |