EDURANT 27.5mg/1 (NDC: 59676027801)
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 | 5 |
Specialty Tier |
33% | 33% | None | $729.63 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | None | $731.73 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | None | $731.73 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | None | $736.72 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | None | $731.96 |
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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $742.62 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days | $729.81 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days | $730.79 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $726.62 |
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 |
CareOne (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $755.16 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $754.22 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $752.59 |
Browse Plan Formulary |
Coventry Summit Select (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $750.57 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $751.35 |
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 Vista Prime (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $750.57 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $712.85 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $711.96 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $710.22 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $710.22 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $726.62 |
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 H1036-186 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $726.62 |
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 | Q:30 /30Days | $724.22 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | n/a | None | $754.85 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $761.11 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $712.84 |
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 |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $712.84 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | n/a | None | $733.13 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | n/a | None | $731.73 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | None | $726.54 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | None | $716.34 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | None | $716.34 |
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 |
Simply More (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | None | $716.34 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | None | $716.34 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$15.00 | n/a | None | $733.41 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$15.00 | n/a | None | $733.41 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $755.16 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | n/a | Q:31 /31Days | $739.52 |
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 Essential (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | n/a | Q:31 /31Days | $739.56 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | n/a | Q:31 /31Days | $739.33 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $728.86 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 | to be determined | 4 |
Tier 4 |
15% | 15% | Q:30 /30Days | $755.16 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:31 /31Days | $740.32 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$8.70 |
$325 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:31 /31Days | $740.13 |
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 Access (HMO SNP)
|
$12.10 |
$325 | to be determined | 4 |
Tier 4 |
25% | n/a | Q:31 /31Days | $740.13 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$12.20 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $769.80 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $728.88 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-185 (HMO SNP)
|
$20.10 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
|
$20.60 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | Q:30 /30Days | $726.62 |
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 Full (HMO SNP)
|
$23.10 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | Q:30 /30Days | $712.25 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$23.20 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO SNP)
|
$23.40 |
$325 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $761.11 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$23.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | None | $731.91 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $45.00 | None | $739.60 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 | Some Generics | 5 |
Specialty Tier |
25% | 25% | None | $731.96 |
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 Vista Maximum (HMO SNP)
|
$24.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $769.80 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $712.25 |
Browse Plan Formulary |
MediMax (HMO)
|
$24.70 |
$325* | No additional gap coverage, only the Donut Hole Discount | 4* |
Non-Preferred Brand |
25% | n/a | None | $727.45 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$24.80 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | Q:30 /30Days | $712.54 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $712.54 |
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 |
Simply Care (HMO SNP)
|
$24.80 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | None | $716.34 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$24.80 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | None | $716.34 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$24.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $716.34 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 | to be determined | 5 |
Tier 5 |
15% | 15% | None | $729.63 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$25.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | Q:30 /30Days | $768.36 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $245.00 | Q:30 /30Days | $724.22 |
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)
|
$33.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | None | $736.65 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | Q:30 /30Days | $726.65 |
Browse Plan Formulary |
Day Break (HMO)
|
$68.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $755.16 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $724.57 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days | $730.31 |
Browse Plan Formulary |
HumanaChoice H5415-068 (PPO)
|
$152.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | Q:30 /30Days | $726.62 |
Browse Plan Formulary |