TOBRAMYCIN OPHTHALMIC SOLUTION 0.3% 5ML BOT (5 ML BOT) (NDC: 24208029005)
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 |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
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 |
PriorityMedicare Value (HMO-POS)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$9.00 | $22.50 | None | $12.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
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 R5826-072 (Regional PPO)
|
$20.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $9.01 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$32.70 |
$325* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Generic |
$0.00 | $0.00 | None | $10.45 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$37.50 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$8.00 | $0.00 | None | $9.01 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
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 |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | None | $12.09 |
Browse Plan Formulary |
HumanaChoice H5470-005 (PPO)
|
$62.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$6.00 | $0.00 | None | $9.01 |
Browse Plan Formulary |
Humana Gold Choice H8145-005 (PFFS)
|
$72.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$7.00 | $0.00 | None | $9.01 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
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)
|
$75.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$75.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$81.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$8.00 | $20.00 | None | $12.58 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$90.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$8.00 | $20.00 | None | $12.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
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)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
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 |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
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)
|
$203.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$203.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$3.00 | $7.50 | None | $12.09 |
Browse Plan Formulary |