Desoximetasone 0.5mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE (1 TUBE in 1 CARTON / 60 g ) (NDC: 51672126103)
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 2 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $216.09 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $213.60 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | None | $212.39 |
Browse Plan Formulary |
Humana Gold Plus H5291-001 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$89.00 | $257.00 | None | $265.61 |
Browse Plan Formulary |
Humana Gold Plus H5291-002 (HMO)
|
$0.00 |
$325 |
Few Generics |
4 |
Non-Preferred Brand |
30% | 30% | None | $265.61 |
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 H5291-002 (HMO)
|
$0.00 |
$325 |
Few Generics |
4 |
Non-Preferred Brand |
30% | 30% | None | $265.61 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Core (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $153.87 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Core Plan (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $163.12 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$9.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $216.09 |
Browse Plan Formulary |
HumanaChoice H0623-011 (PPO)
|
$12.80 |
$325 |
Few Generics |
4 |
Non-Preferred Brand |
30% | 30% | None | $265.79 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Silver (HMO)
|
$18.10 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $153.87 |
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 |
Humana Gold Plus H5291-001 (HMO)
|
$27.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$89.00 | $257.00 | None | $265.61 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Plus Choice (HMO-POS)
|
$27.30 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $153.87 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$28.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $214.92 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$29.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $214.92 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$29.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $214.92 |
Browse Plan Formulary |
HumanaChoice H0623-001 (PPO)
|
$29.80 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$84.00 | $242.00 | None | $265.79 |
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 |
SureValue Select (HMO)
|
$31.10 |
$60 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $208.18 |
Browse Plan Formulary |
Humana Gold Choice H8145-123 (PFFS)
|
$31.30 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$89.00 | $257.00 | None | $265.79 |
Browse Plan Formulary |
Colorado Access Advantage Peak Plan (HMO)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $14.00 | None | $205.45 |
Browse Plan Formulary |
Colorado Access Advantage Peak Plan (HMO)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $14.00 | None | $205.45 |
Browse Plan Formulary |
Colorado Access Advantage Summit Plan (HMO SNP)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.50 | $15.00 | None | $205.45 |
Browse Plan Formulary |
Colorado Access Advantage Summit Plan (HMO SNP)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.50 | $15.00 | None | $205.45 |
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 Medicaid Plan (HMO SNP)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $153.87 |
Browse Plan Formulary |
Aetna Medicare Select Plan (PPO)
|
$38.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | None | $212.39 |
Browse Plan Formulary |
HumanaChoice H0623-011 (PPO)
|
$39.00 |
$325 |
Few Generics |
4 |
Non-Preferred Brand |
30% | 30% | None | $265.79 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$40.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$42.00 | $116.00 | None | $213.60 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Silver Plan (HMO)
|
$40.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $163.12 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$40.50 |
$90 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$43.00 | $107.50 | None | $208.18 |
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 |
Rocky Mountain Thrifty Plan + Rx (Cost)
|
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $209.76 |
Browse Plan Formulary |
Rocky Mountain Green Plan + Rx (Cost)
|
$51.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$13.00 | $39.00 | None | $209.76 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Gold (HMO)
|
$55.70 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $153.87 |
Browse Plan Formulary |
Rocky Mountain Green Plan + Rx (Cost)
|
$56.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$13.00 | $39.00 | None | $209.76 |
Browse Plan Formulary |
HumanaChoice H0623-001 (PPO)
|
$70.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$84.00 | $242.00 | None | $265.79 |
Browse Plan Formulary |
Rocky Mountain Thrifty Plan + Rx (Cost)
|
$74.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $209.76 |
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 |
Rocky Mountain Standard Plan + Rx (Cost)
|
$77.70 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $209.76 |
Browse Plan Formulary |
Humana Gold Choice H8145-123 (PFFS)
|
$81.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$89.00 | $257.00 | None | $265.79 |
Browse Plan Formulary |
Rocky Mountain Plus Plan + Rx (Cost)
|
$102.80 |
$0 |
All Generics |
2 |
Non-Preferred Generic |
$9.00 | $22.50 | None | $209.76 |
Browse Plan Formulary |
Rocky Mountain Standard Plan + Rx (Cost)
|
$103.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $209.76 |
Browse Plan Formulary |
Rocky Mountain Plus Plan + Rx (Cost)
|
$249.80 |
$0 |
All Generics |
2 |
Non-Preferred Generic |
$9.00 | $22.50 | None | $209.76 |
Browse Plan Formulary |