IXEMPRA 45 MG KIT (1 KIT in 1 PACKAGE, COMBI ) (NDC: 00015191113)
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 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | None | $3,149.33 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | None | $3,149.33 |
Browse Plan Formulary |
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 | $3,066.18 |
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 | $3,149.33 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | None | $3,054.77 |
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 Advantra Select Plus (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | n/a | P | $3,165.75 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $3,089.23 |
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% | P | $3,089.23 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $3,089.23 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $3,089.23 |
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% | P | $3,089.23 |
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 VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | 33% | P | $3,089.23 |
Browse Plan Formulary |
Humana Gold Plus H1036-067 (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:45 /21Days | $3,130.81 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:45 /21Days | $3,130.81 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-160 (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:45 /21Days | $3,130.81 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:45 /21Days | $3,130.81 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO-POS SNP)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $3,164.08 |
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 Diamond Rewards COPD (HMO-POS SNP)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $3,164.08 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $3,164.08 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
4 |
Specialty Tier |
33% | 33% | P | $3,164.08 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | n/a | P | $3,150.18 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P | $3,150.18 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P | $3,150.18 |
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 |
Ultimate Premier (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$45.00 | $135.00 | P | $3,192.40 |
Browse Plan Formulary |
Ultimate Premier Plus (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$40.00 | $120.00 | P | $3,192.40 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | n/a | P | $3,216.56 |
Browse Plan Formulary |
WellCare Essential (HMO)
|
$0.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | n/a | P | $3,216.56 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
All Generics |
4 |
Specialty Tier |
33% | n/a | P | $3,216.56 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,163.91 |
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 Liberty (HMO SNP)
|
$8.70 |
$325 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,163.91 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.10 |
$325 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,163.91 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-102 (HMO SNP)
|
$14.70 |
$325 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:45 /21Days | $3,130.81 |
Browse Plan Formulary |
Coventry Advantra Maximum (HMO SNP)
|
$17.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,156.09 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-161 (HMO SNP)
|
$19.70 |
$325 |
to be determined |
5 |
Tier 5 |
25% | n/a | P Q:45 /21Days | $3,130.81 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO SNP)
|
$22.10 |
$325 |
to be determined |
5 |
Tier 5 |
15% | 15% | None | $3,149.33 |
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 | P | $3,089.23 |
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 | $3,066.18 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 |
to be determined |
4 |
Tier 4 |
$95.00 | $95.00 | None | $3,089.51 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $3,089.23 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$24.80 |
$325 |
to be determined |
1 |
Tier 1 |
n/a | n/a | P | $3,089.23 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $3,089.23 |
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 | P | $3,151.16 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$24.80 |
$0 |
Many Generics |
5 |
Specialty Tier |
33% | n/a | P | $3,151.16 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$24.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $3,150.18 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 |
to be determined |
5 |
Tier 5 |
15% | 15% | None | $3,066.18 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:45 /21Days | $3,130.81 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 |
Few Generics, Few Brands |
5 |
Specialty Tier |
33% | n/a | P Q:45 /21Days | $3,130.81 |
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 |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
33% | 33% | None | $3,132.31 |
Browse Plan Formulary |