LETAIRIS 5MG TABLET (NDC: 61958080102)
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 | $6,601.73 |
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 | $6,601.73 |
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 | $6,634.67 |
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 | $6,601.73 |
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% | P Q:30 /30Days | $7,019.16 |
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 Q:30 /30Days | $6,816.37 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P | $6,651.23 |
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 | $6,651.23 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P | $6,651.23 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P | $6,651.23 |
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 | $6,651.23 |
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 | $6,651.23 |
Browse Plan Formulary |
Humana Gold Plus H1036-067 (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,740.73 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,740.73 |
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:30 /30Days | $6,740.73 |
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:30 /30Days | $6,740.73 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO-POS SNP)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P | $6,651.23 |
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 |
Optimum Diamond Rewards COPD (HMO-POS SNP)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P | $6,651.23 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P | $6,651.23 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P | $6,651.23 |
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 Q:30 /30Days | $6,782.18 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,647.48 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,647.48 |
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 | 5 |
Specialty Tier |
33% | 33% | None | $6,872.29 |
Browse Plan Formulary |
Ultimate Premier Plus (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | None | $6,872.29 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,924.76 |
Browse Plan Formulary |
WellCare Essential (HMO)
|
$0.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,924.76 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | All Generics | 4 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,924.76 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:30 /30Days | $6,752.89 |
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 Q:30 /30Days | $6,752.89 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.10 |
$325 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:30 /30Days | $6,752.89 |
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:30 /30Days | $6,740.73 |
Browse Plan Formulary |
Coventry Advantra Maximum (HMO SNP)
|
$17.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:30 /30Days | $6,795.52 |
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:30 /30Days | $6,740.73 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO SNP)
|
$22.10 |
$325 | to be determined | 5 |
Tier 5 |
15% | 15% | None | $6,601.73 |
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 |
Freedom Medi-Medi Full (HMO SNP)
|
$23.10 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | P | $6,651.23 |
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 | $6,634.67 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $45.00 | None | $6,645.33 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | P | $6,651.23 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | P | $6,651.23 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | P | $6,651.23 |
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 Q:30 /30Days | $6,647.48 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$24.80 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,647.48 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$24.80 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $6,647.48 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 | to be determined | 5 |
Tier 5 |
15% | 15% | None | $6,634.67 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,740.73 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 | Few Generics, Few Brands | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $6,740.73 |
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 |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P Q:30 /30Days | $6,584.51 |
Browse Plan Formulary |