SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE (60 TABLET, FILM COATED in ) (NDC: 49702022318)
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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,117.55 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,143.21 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,123.45 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,132.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,130.88 |
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 |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,123.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,143.21 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,123.45 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,132.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,130.88 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$20.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:240 /30Days | $1,121.20 |
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 |
HumanaChoice R5826-006 (Regional PPO)
|
$37.50 |
$0 |
Few Generics, Few Brands |
4 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $1,121.20 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$46.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | None | $1,118.56 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,132.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,130.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,123.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,143.21 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | None | $1,123.45 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$57.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | None | $1,120.50 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$57.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | None | $1,116.86 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$57.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | None | $1,118.56 |
Browse Plan Formulary |
HumanaChoice H5470-002 (PPO)
|
$62.00 |
$0 |
Few Generics, Few Brands |
4 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $1,121.52 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$72.00 |
$0 |
Few Generics, Few Brands |
4 |
Specialty Tier |
33% | n/a | Q:240 /30Days | $1,119.80 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$88.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,123.45 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$88.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,132.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$88.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,130.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$88.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,117.55 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$88.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,143.21 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | None | $1,123.45 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | None | $1,132.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | None | $1,130.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | None | $1,123.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$128.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Specialty Tier |
30% | n/a | None | $1,143.21 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | None | $1,118.56 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$134.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
33% | n/a | None | $1,118.56 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,143.21 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,123.45 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,132.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,130.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,123.38 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,132.58 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,130.88 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,117.55 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,143.21 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 |
Many Generics |
5 |
Specialty Tier |
30% | n/a | None | $1,123.45 |
Browse Plan Formulary |