FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN (5 SYSTEMS CRTN) (NDC: 00591319872)
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 |
Advantra Elite (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$24.00 | $60.00 | Q:10 /30Days | $30.65 |
Browse Plan Formulary |
Advantra Silver (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$24.00 | $60.00 | Q:10 /30Days | $30.67 |
Browse Plan Formulary |
Advantra Silver (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$25.00 | $62.50 | Q:10 /30Days | $30.65 |
Browse Plan Formulary |
Bravo-HealthSpring Achieve (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $21.00 | Q:15 /30Days | $29.68 |
Browse Plan Formulary |
Bravo-HealthSpring Classic (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $21.00 | Q:15 /30Days | $29.68 |
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 Blue PPO HD Rx (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $33.82 |
Browse Plan Formulary |
Gateway Health Plan Medicare Assured Select (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:10 /30Days | $29.05 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $33.04 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $31.90 |
Browse Plan Formulary |
HumanaChoice H6900-004 (PPO)
|
$26.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:20 /30Days | $32.53 |
Browse Plan Formulary |
Today''s Options Advantage Plus 550B (PPO)
|
$28.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:10 /30Days | $42.97 |
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 R5826-081 (Regional PPO)
|
$30.10 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | Q:20 /30Days | $32.53 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$30.40 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
n/a | n/a | None | $32.56 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$31.70 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:20 /30Days | $32.53 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$33.70 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $34.00 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$36.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$33.00 | $66.00 | Q:15 /30Days | $36.19 |
Browse Plan Formulary |
AmeriHealth VIP Care (HMO SNP)
|
$36.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:10 /30Days | $33.25 |
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 |
Gateway Health Plan Medicare Assured 3 (HMO SNP)
|
$36.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | n/a | Q:10 /30Days | $29.04 |
Browse Plan Formulary |
Gateway Health Plan Medicare Assured (HMO SNP)
|
$36.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | Q:10 /30Days | $29.04 |
Browse Plan Formulary |
Bravo-HealthSpring Select (HMO SNP)
|
$36.60 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:15 /30Days | $29.68 |
Browse Plan Formulary |
Geisinger Gold Secure 1 (HMO SNP)
|
$38.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:10 /30Days | $27.91 |
Browse Plan Formulary |
Advantra Cares (HMO SNP)
|
$38.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
15% | 15% | Q:10 /30Days | $30.68 |
Browse Plan Formulary |
Today''s Options Premier Plus 550B (PFFS)
|
$40.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:10 /30Days | $42.97 |
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 |
Geisinger Gold Classic 3 $0 Deductible Rx (HMO)
|
$41.00 |
$0 | Few Generics | 2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:10 /30Days | $27.77 |
Browse Plan Formulary |
Advantra Silver Plus (PPO)
|
$43.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$25.00 | $62.50 | Q:10 /30Days | $30.65 |
Browse Plan Formulary |
Gateway Health Plan Medicare Assured Select Plus (HMO SNP)
|
$44.50 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $30.00 | Q:10 /30Days | $29.05 |
Browse Plan Formulary |
Geisinger Gold Preferred 2 $0 Deductible Rx (PPO)
|
$55.00 |
$0 | Few Generics | 2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:10 /30Days | $27.79 |
Browse Plan Formulary |
Humana Gold Choice H8145-052 (PFFS)
|
$56.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:20 /30Days | $32.53 |
Browse Plan Formulary |
Freedom Blue PPO ValueRx (PPO)
|
$60.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $33.82 |
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 |
SeniorBlue - Option 2 (PPO)
|
$63.70 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$20.00 | $60.00 | Q:30 /30Days | $35.95 |
Browse Plan Formulary |
Geisinger Gold Preferred 1 $0 Deductible Rx (PPO)
|
$74.00 |
$0 | Few Generics | 2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:10 /30Days | $27.71 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$93.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$23.00 | $57.50 | Q:10 /30Days | $30.65 |
Browse Plan Formulary |
Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS)
|
$100.00 |
$0 | Few Generics | 2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:10 /30Days | $27.71 |
Browse Plan Formulary |
Today''s Options Advantage Plus 150A (PPO)
|
$105.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$7.00 | $14.00 | Q:10 /30Days | $42.97 |
Browse Plan Formulary |
Today''s Options Premier Plus 150A (PFFS)
|
$105.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$7.00 | $14.00 | Q:10 /30Days | $42.97 |
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)
|
$120.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$33.00 | $66.00 | Q:15 /30Days | $35.70 |
Browse Plan Formulary |
Geisinger Gold Secure 3 (HMO SNP)
|
$123.00 |
$0 | Few Generics | 2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:10 /30Days | $27.80 |
Browse Plan Formulary |
HumanaChoice H6900-005 (PPO)
|
$132.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:20 /30Days | $32.53 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx (HMO)
|
$142.00 |
$0 | Few Generics | 2 |
Non-Preferred Generic |
$7.00 | $21.00 | Q:10 /30Days | $27.71 |
Browse Plan Formulary |
Freedom Blue PPO Standard (PPO)
|
$165.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $33.82 |
Browse Plan Formulary |
SeniorBlue - Option 1 (PPO)
|
$180.70 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$15.00 | $45.00 | Q:30 /30Days | $35.95 |
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 Blue PPO Deluxe (PPO)
|
$208.00 |
$0 | Many Generics | 1 |
Generic |
$8.00 | $20.00 | None | $33.82 |
Browse Plan Formulary |