DIOVAN HCT 160/12.5MG TABLET (90 BOT) (NDC: 00078031534)
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)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $135.52 |
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AARP MedicareComplete Choice (PPO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $135.52 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Choice Plan 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $135.50 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $135.52 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days | $135.83 |
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 Regional PPO (Regional PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Regional PPO (Regional PPO)](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 | $285.00 | S Q:30 /30Days | $135.76 |
Browse Plan Formulary |
CareDirect (HMO SNP)
![Email Prescription and/or Health Benefit details for CareDirect (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:30 /30Days | $135.62 |
Browse Plan Formulary |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$25.00 | $65.00 | Q:30 /30Days | $135.65 |
Browse Plan Formulary |
CareOne (HMO)
![Email Prescription and/or Health Benefit details for CareOne (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$25.00 | $65.00 | Q:30 /30Days | $135.71 |
Browse Plan Formulary |
CareOne PLUS (HMO)
![Email Prescription and/or Health Benefit details for CareOne PLUS (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:30 /30Days | $135.65 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
![Email Prescription and/or Health Benefit details for Clear Skies (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$10.00 | $30.00 | Q:30 /30Days | $140.44 |
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 |
Freedom Medicare Plan Rx (HMO)
![Email Prescription and/or Health Benefit details for Freedom Medicare Plan Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $137.84 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
![Email Prescription and/or Health Benefit details for Freedom Savings Plan Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$65.00 | $130.00 | S Q:30 /30Days | $137.97 |
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 |
3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $137.81 |
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 |
3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $137.81 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $137.81 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings COPD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $137.81 |
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 |
Humana Gold Plus H1036-025 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-025 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:30 /30Days | $135.44 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-141 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$25.00 | $65.00 | Q:30 /30Days | $135.71 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-160 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DB H1036-160 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$0.00 | $0.00 | Q:30 /30Days | $135.71 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
![Email Prescription and/or Health Benefit details for Humana Reader''s Digest Healthy Living Plan (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $135.46 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for Optimum Diamond Rewards (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$50.00 | $100.00 | S Q:30 /30Days | $137.82 |
Browse Plan Formulary |
Optimum Diamond Rewards COPD (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for Optimum Diamond Rewards COPD (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$50.00 | $100.00 | S Q:30 /30Days | $137.82 |
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 Gold Rewards Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Optimum Gold Rewards Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$69.00 | $138.00 | S Q:30 /30Days | $137.77 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Optimum Platinum Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $137.77 |
Browse Plan Formulary |
Sunrise (HMO)
![Email Prescription and/or Health Benefit details for Sunrise (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$10.00 | $30.00 | Q:30 /30Days | $140.44 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
![Email Prescription and/or Health Benefit details for Sunny Days (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.00 |
$325 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:30 /30Days | $140.44 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-102 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | Q:30 /30Days | $135.71 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-161 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-161 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.70 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | Q:30 /30Days | $135.71 |
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 PLUS (HMO SNP)
![Email Prescription and/or Health Benefit details for CareNeeds PLUS (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.80 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | Q:30 /30Days | $135.71 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete LP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $135.52 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Full (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.10 |
$325 |
to be determined |
1 |
Tier 1 |
n/a | n/a | S Q:30 /30Days | $137.87 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $135.50 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Sunshine State Health Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$325 |
to be determined |
2 |
Tier 2 |
$45.00 | $45.00 | Q:30 /30Days | $137.35 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
![Email Prescription and/or Health Benefit details for CareNeeds (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.10 |
$325 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | Q:30 /30Days | $135.65 |
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 Medi-Medi Partial (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Partial (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.70 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $137.87 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Full (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.80 |
$325 |
to be determined |
1 |
Tier 1 |
n/a | n/a | S Q:30 /30Days | $137.85 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Partial (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.80 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $137.85 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete EV (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete EV (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.80 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $135.53 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete RP (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.80 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $135.50 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-005 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.10 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$40.00 | $110.00 | Q:30 /30Days | $135.46 |
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 |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:1 /1Days | $136.70 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:1 /1Days | $136.81 |
Browse Plan Formulary |
Day Break (HMO)
![Email Prescription and/or Health Benefit details for Day Break (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$77.50 |
$0 |
All Generics |
2 |
Preferred Brand |
$20.00 | $60.00 | Q:30 /30Days | $140.44 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-061 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$102.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $135.45 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$152.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | S Q:30 /30Days | $135.87 |
Browse Plan Formulary |