TRAMADOL HYDROCHLORIDE 200mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC (30 TABLET, EXTENDED RELEA ) (NDC: 49884082211)
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 | 2 |
Tier 2 |
25% | 25% | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $136.58 |
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 |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 0 (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$6.00 | $12.00 | Q:30 /30Days | $107.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
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 |
HealthPlus MedicarePlus-Advantage D-SNP (HMO SNP)
|
$23.60 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:30 /30Days | $107.36 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
n/a | n/a | None | $118.35 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$44.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | None | $109.16 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$54.00 |
$50 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | None | $109.16 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$55.60 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$9.00 | $22.50 | None | $100.68 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 1 (HMO-POS)
|
$79.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$7.00 | $14.00 | Q:30 /30Days | $107.20 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$94.00 |
$25 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | None | $109.16 |
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 |
PriorityMedicare Merit (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $100.68 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $100.68 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$10.00 | $25.00 | None | $100.68 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$103.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | None | $109.16 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
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 Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$122.00 |
$50 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $109.16 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS)
|
$125.00 |
$0 | All Generics | 1 |
Generic |
$6.00 | $12.00 | Q:30 /30Days | $107.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $136.58 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$15.00 | $37.50 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$136.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $100.68 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$154.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$8.00 | $20.00 | None | $100.68 |
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 |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$169.00 |
$25 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $109.16 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$174.00 |
$50 | All Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $109.16 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
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 | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:31 /31Days | $136.58 |
Browse Plan Formulary |