ULORIC TABLETS 40MG 30 BOT (30 BOT) (NDC: 64764091830)
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 |
3 |
Tier 3 |
25% | 25% | S | $213.77 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S | $214.22 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S | $214.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S | $214.26 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S | $214.00 |
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 |
2 |
Preferred Brand |
$33.00 | $66.00 | None | $208.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $213.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $214.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $213.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $214.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $213.73 |
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 |
HumanaChoice R5826-072 (Regional PPO)
|
$20.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | S Q:30 /30Days | $212.13 |
Browse Plan Formulary |
HealthPlus MedicarePlus-Advantage D-SNP (HMO SNP)
|
$23.60 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $208.96 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$37.50 |
$0 |
Few Generics, Few Brands |
2 |
Preferred Brand |
$40.00 | $110.00 | S Q:30 /30Days | $212.13 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$43.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $212.76 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$47.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $212.67 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$47.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $212.76 |
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)
|
$47.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$90.00 | $225.00 | S | $213.24 |
Browse Plan Formulary |
HumanaChoice H5470-005 (PPO)
|
$62.00 |
$0 |
Few Generics, Few Brands |
2 |
Preferred Brand |
$45.00 | $125.00 | S Q:30 /30Days | $211.65 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $213.73 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $214.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $213.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $213.90 |
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)
|
$76.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | S Q:31 /31Days | $214.22 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 1 (HMO-POS)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$39.00 | $78.00 | None | $208.94 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $214.26 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $214.00 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $213.77 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $214.22 |
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)
|
$96.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S | $214.10 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$107.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$80.00 | $200.00 | S | $212.76 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$111.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$85.00 | $212.50 | S | $212.76 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS)
|
$125.00 |
$0 |
All Generics |
2 |
Preferred Brand |
$35.00 | $70.00 | None | $208.94 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | S Q:31 /31Days | $214.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | S Q:31 /31Days | $213.73 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | S Q:31 /31Days | $213.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | S Q:31 /31Days | $214.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | S Q:31 /31Days | $213.90 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantagePPO Enhanced (PPO)
|
$136.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$35.00 | $70.00 | None | $208.96 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $214.00 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $213.77 |
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)
|
$213.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $214.22 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $214.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | S | $214.26 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S Q:31 /31Days | $213.14 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S Q:31 /31Days | $214.22 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S Q:31 /31Days | $213.19 |
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)
|
$240.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S Q:31 /31Days | $213.32 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | S Q:31 /31Days | $213.13 |
Browse Plan Formulary |