VIIBRYD 40mg/1 30 FILM COATED TABLETS in BOTTLE (30 TABLET, FILM COATED in ) (NDC: 00456114030)
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 SecureHorizons (HMO)
|
$0.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $142.83 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 |
Some Generics |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | Q:1 /1Days | $143.85 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $144.97 |
Browse Plan Formulary |
Care Improvement Plus Copper RX (Regional PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $145.00 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $144.97 |
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 |
Care Improvement Plus Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $145.00 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $144.97 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $112.50 | None | $145.00 |
Browse Plan Formulary |
Care N'' Care Health Plan III (PPO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$70.00 | $210.00 | None | $142.78 |
Browse Plan Formulary |
HealthSpring Achieve (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$70.00 | $200.00 | S Q:30 /30Days | $138.30 |
Browse Plan Formulary |
HealthSpring Preferred (HMO)
|
$0.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$70.00 | $200.00 | S Q:30 /30Days | $137.88 |
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 |
Humana Gold Plus H4510-018 (HMO)
|
$0.00 |
$125 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | Q:30 /30Days | $143.73 |
Browse Plan Formulary |
TexanPlus Classic (HMO)
|
$0.00 |
$0 |
Many Generics, Few Brands |
3 |
Preferred Brand |
$40.00 | $80.00 | None | $143.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$22.60 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | None | $142.83 |
Browse Plan Formulary |
Care N'' Care Health Plan II (PPO)
|
$29.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$68.00 | $204.00 | None | $142.78 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$29.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$89.00 | $257.00 | Q:30 /30Days | $143.71 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (HMO SNP)
|
$29.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $142.82 |
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 |
Advantage by Superior HealthPlan (HMO SNP)
|
$30.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $45.00 | None | $144.60 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$30.90 |
$325 |
Many Generics, Few Brands |
2 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days | $142.07 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-023 (HMO SNP)
|
$31.70 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
n/a | n/a | Q:30 /30Days | $143.73 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $144.97 |
Browse Plan Formulary |
Care Improvement Plus Chrome RX (Regional PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $145.00 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | None | $144.97 |
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 |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | None | $145.00 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $144.97 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional PPO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $145.00 |
Browse Plan Formulary |
HealthSpring TotalCare (HMO SNP)
|
$31.80 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $137.88 |
Browse Plan Formulary |
Today''s Options Advantage Plus 650B (PPO)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $143.21 |
Browse Plan Formulary |
HealthSpring Preferred (PPO)
|
$35.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$60.00 | $170.00 | S Q:30 /30Days | $137.10 |
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 |
Erickson Advantage Freedom (HMO-POS)
|
$48.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$85.00 | $245.00 | None | $142.82 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
|
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | Q:1 /1Days | $143.85 |
Browse Plan Formulary |
Humana Prime Choice H4520-006 (PPO)
|
$57.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$83.00 | $239.00 | Q:30 /30Days | $143.74 |
Browse Plan Formulary |
Today''s Options Premier Plus 650B (PFFS)
|
$66.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $143.21 |
Browse Plan Formulary |
Blue Medicare Advantage (PPO)
|
$69.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$95.00 | $237.50 | S Q:30 /30Days | $143.45 |
Browse Plan Formulary |
Care N'' Care Health Plan I (PPO)
|
$75.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$65.00 | $195.00 | None | $142.78 |
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 Choice H8145-084 (PFFS)
|
$87.00 |
$0 |
Few Generics, Few Brands |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | Q:30 /30Days | $143.72 |
Browse Plan Formulary |
Today''s Options Advantage Plus 350A (PPO)
|
$107.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $80.00 | None | $143.21 |
Browse Plan Formulary |
Today''s Options Premier Plus 350A (PFFS)
|
$122.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$40.00 | $80.00 | None | $143.21 |
Browse Plan Formulary |
Erickson Advantage Champion (HMO-POS SNP)
|
$176.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $142.82 |
Browse Plan Formulary |
Erickson Advantage Signature with Drugs (HMO-POS)
|
$176.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $142.82 |
Browse Plan Formulary |