Levofloxacin 750mg/1 (NDC: 68180024201)
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 |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $41.96 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $41.63 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $42.13 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $41.96 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$4.00 | $8.00 | None | $173.54 |
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 HMO (HMO)
|
$0.00 |
$0 |
All Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $26.53 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $15.00 | None | $28.08 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
Some Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $26.20 |
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 |
Clear Skies (HMO SNP)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $26.25 |
Browse Plan Formulary |
Coventry Advantra Ideal (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $48.79 |
Browse Plan Formulary |
Coventry Advantra Select Plus (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $48.78 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:14 /14Days | $28.65 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$25.00 | $50.00 | Q:14 /14Days | $31.01 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$5.00 | $10.00 | Q:14 /14Days | $29.89 |
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 |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$5.00 | $10.00 | Q:14 /14Days | $29.89 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:14 /14Days | $29.89 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:14 /14Days | $29.89 |
Browse Plan Formulary |
Humana Gold Plus H1036-025 (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-160 (HMO SNP)
|
$0.00 |
$0 |
Many Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $26.20 |
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 |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$15.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
Optimum Diamond Rewards (HMO-POS SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:14 /14Days | $31.79 |
Browse Plan Formulary |
Optimum Diamond Rewards COPD (HMO-POS SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:14 /14Days | $31.79 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$20.00 | $40.00 | Q:14 /14Days | $28.22 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$5.00 | $10.00 | Q:14 /14Days | $28.22 |
Browse Plan Formulary |
PUP PLUS (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $38.54 |
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 |
PUP SIMPLE (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $38.54 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $56.67 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $56.67 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $26.25 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $20.61 |
Browse Plan Formulary |
WellCare Essential (HMO)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $20.61 |
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 |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $20.61 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $42.87 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$5.00 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $26.25 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $20.61 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$8.70 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $20.61 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.10 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $20.61 |
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 |
Humana Gold Plus SNP-DE H1036-102 (HMO SNP)
|
$14.70 |
$325* |
to be determined |
2* |
Tier 2 |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
Coventry Advantra Maximum (HMO SNP)
|
$17.70 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | Q:30 /30Days | $56.23 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $216.54 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-161 (HMO SNP)
|
$19.70 |
$325* |
to be determined |
2* |
Tier 2 |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$19.80 |
$325* |
to be determined |
2* |
Tier 2 |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO SNP)
|
$22.10 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $41.91 |
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 |
Freedom Medi-Medi Full (HMO SNP)
|
$23.10 |
$325 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:14 /14Days | $29.45 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$23.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $42.02 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | Q:14 /14Days | $27.95 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$24.10 |
$325* |
to be determined |
2* |
Tier 2 |
$0.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $173.54 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | Q:14 /14Days | $29.45 |
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 Emerald Full (HMO SNP)
|
$24.80 |
$325 |
to be determined |
1 |
Tier 1 |
n/a | n/a | Q:14 /14Days | $29.67 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 |
to be determined |
1 |
Tier 1 |
15% | 15% | Q:14 /14Days | $29.67 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$24.80 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $56.67 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$24.80 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $56.67 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$24.80 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $56.67 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete EV (HMO SNP)
|
$24.80 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $41.60 |
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 RP (Regional PPO SNP)
|
$24.80 |
$325 |
to be determined |
3 |
Tier 3 |
15% | 15% | None | $42.13 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$8.00 | $0.00 | None | $26.20 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | None | $81.11 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$39.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $66.00 | None | $87.53 |
Browse Plan Formulary |
Day Break (HMO)
|
$77.50 |
$0 |
All Generics |
1 |
Generic |
$0.00 | $0.00 | None | $26.25 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 |
Few Generics, Few Brands |
2 |
Non-Preferred Generic |
$15.00 | $0.00 | None | $26.20 |
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 |
2 |
Non-Preferred Generic |
$17.00 | $24.00 | None | $30.17 |
Browse Plan Formulary |