ENDODAN TABLETS 325;4.8355MG;MG 100 BOT (100 BOT) (NDC: 60951031070)
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)
|
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $95.86 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $95.86 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
Some Generics |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $100.16 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Premier (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $100.16 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$13.00 | $19.50 | Q:360 /30Days | $110.39 |
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 |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$13.00 | $19.50 | Q:360 /30Days | $110.39 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$13.00 | $19.50 | Q:360 /30Days | $110.39 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$13.00 | $19.50 | Q:360 /30Days | $110.39 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$5.00 | $10.00 | Q:360 /30Days | $98.29 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$5.00 | $10.00 | Q:360 /30Days | $98.29 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:120 /30Days | $110.22 |
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 |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:120 /30Days | $96.04 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:120 /30Days | $96.04 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$325 |
All Generics, Few Brands |
3 |
Preferred Brand |
25% | 25% | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
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 ESRD (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
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 Touch (HMO SNP)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $126.78 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
All Generics, All Brands |
3 |
Preferred Brand |
$25.00 | $62.50 | Q:360 /30Days | $126.78 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$0.00 | $0.00 | None | $96.51 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Generic |
$0.00 | $0.00 | None | $96.51 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:360 /30Days | $99.37 |
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)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:360 /30Days | $99.37 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:360 /30Days | $100.29 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:360 /30Days | $100.29 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:360 /30Days | $100.29 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:360 /30Days | $100.29 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO) (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:372 /31Days | $96.61 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
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 |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.00 | $16.00 | None | $151.18 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$8.00 | $16.00 | None | $151.18 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $159.80 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $159.80 |
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 |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | n/a | Q:120 /30Days | $96.04 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | Q:360 /30Days | $136.70 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $151.18 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $151.18 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$23.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
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 |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $95.86 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$28.00 |
$90 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$14.00 | $21.00 | Q:360 /30Days | $110.39 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:360 /30Days | $98.29 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:360 /30Days | $98.29 |
Browse Plan Formulary |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:360 /30Days | $98.29 |
Browse Plan Formulary |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | Q:360 /30Days | $98.29 |
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 HMO Extra Care (HMO)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:360 /30Days | $98.29 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | Q:360 /30Days | $98.29 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325 |
Few Generics |
2 |
Non-Preferred Generic |
25% | 25% | Q:120 /30Days | $110.22 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325 |
Few Generics |
2 |
Non-Preferred Generic |
25% | 25% | Q:120 /30Days | $96.04 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $101.71 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $101.71 |
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 |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $101.71 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $101.71 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$29.80 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Generic |
$0.00 | $0.00 | Q:360 /30Days | $107.42 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$29.90 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
25% | 25% | Q:360 /30Days | $99.92 |
Browse Plan Formulary |
Freedom Plan (HMO SNP)
|
$29.90 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:360 /30Days | $97.15 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | Q:360 /30Days | $97.15 |
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 |
UnitedHealthcare Dual Complete (HMO SNP)
|
$29.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | None | $100.16 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $101.71 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$66.00 |
$90 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$17.00 | $25.50 | Q:360 /30Days | $110.39 |
Browse Plan Formulary |