Furosemide 10mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 4 mL in 1 VIAL, SINGLE-DOSE (25 VIAL, SINGLE-DOSE in 1 ) (NDC: 00517570425)
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 | 1 |
Preferred Generic |
$5.00 | $12.50 | None | $46.71 |
Browse Plan Formulary |
Advantra Silver (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$6.00 | $15.00 | None | $46.70 |
Browse Plan Formulary |
Advantra Silver (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$6.00 | $15.00 | None | $46.71 |
Browse Plan Formulary |
Bravo-HealthSpring Achieve (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $15.66 |
Browse Plan Formulary |
Bravo-HealthSpring Classic (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $15.66 |
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 | $24.58 |
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 | None | $4.71 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $44.18 |
Browse Plan Formulary |
UnitedHealthcare MedicareComplete Choice (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $45.26 |
Browse Plan Formulary |
HumanaChoice H6900-004 (PPO)
|
$26.00 |
$0 | Few Generics, Few Brands | 1 |
Preferred Generic |
$6.00 | $0.00 | None | $62.20 |
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 | None | $45.24 |
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 | 1 |
Tier 1 |
25% | 25% | None | $60.53 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$30.40 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | None | $44.64 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$31.70 |
$0 | Few Generics, Few Brands | 1 |
Preferred Generic |
$6.00 | $0.00 | None | $60.53 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$33.70 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $44.29 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$36.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$6.00 | $12.00 | None | $39.61 |
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% | None | $31.57 |
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 | None | $4.70 |
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 | None | $4.70 |
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% | None | $15.66 |
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% | None | $21.23 |
Browse Plan Formulary |
Advantra Cares (HMO SNP)
|
$38.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $46.68 |
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 | None | $43.73 |
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 | 1 |
Preferred Generic |
$3.00 | $9.00 | None | $20.68 |
Browse Plan Formulary |
Advantra Silver Plus (PPO)
|
$43.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$6.00 | $15.00 | None | $46.71 |
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 | None | $4.71 |
Browse Plan Formulary |
Geisinger Gold Preferred 2 $0 Deductible Rx (PPO)
|
$55.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$3.00 | $9.00 | None | $20.73 |
Browse Plan Formulary |
Humana Gold Choice H8145-052 (PFFS)
|
$56.00 |
$0 | Few Generics, Few Brands | 1 |
Preferred Generic |
$6.00 | $0.00 | None | $59.46 |
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 | $24.58 |
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 | None | $42.21 |
Browse Plan Formulary |
Geisinger Gold Preferred 1 $0 Deductible Rx (PPO)
|
$74.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$3.00 | $9.00 | None | $20.48 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$93.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$2.00 | $5.00 | None | $46.71 |
Browse Plan Formulary |
Geisinger Gold Classic Plus $0 Deductible Rx (HMO-POS)
|
$100.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$3.00 | $9.00 | None | $20.48 |
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 | None | $45.24 |
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 | None | $43.73 |
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 | 1 |
Preferred Generic |
$6.00 | $12.00 | None | $37.63 |
Browse Plan Formulary |
Geisinger Gold Secure 3 (HMO SNP)
|
$123.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$3.00 | $9.00 | None | $20.84 |
Browse Plan Formulary |
HumanaChoice H6900-005 (PPO)
|
$132.00 |
$0 | Few Generics, Few Brands | 1 |
Preferred Generic |
$6.00 | $0.00 | None | $62.17 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx (HMO)
|
$142.00 |
$0 | Few Generics | 1 |
Preferred Generic |
$3.00 | $9.00 | None | $20.48 |
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 | $24.58 |
Browse Plan Formulary |
SeniorBlue - Option 1 (PPO)
|
$180.70 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$15.00 | $45.00 | None | $42.21 |
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 | $24.58 |
Browse Plan Formulary |