ASMANEX TWISTHALER 110 MCG #30 (0.135 G GM ) (NDC: 00085146102)
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 Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | None | $270.96 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$89.00 | $257.00 | None | $270.60 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$92.00 | $266.00 | None | $270.60 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | None | $272.02 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$35.00 | $70.00 | Q:2 /30Days | $271.17 |
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 |
BlueMedicare HMO (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:1 /30Days | $272.71 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:1 /30Days | $271.96 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $272.21 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | None | $272.21 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | None | $272.21 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$40.00 | $120.00 | Q:2 /30Days | $279.91 |
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 |
Coventry Summit Ideal (HMO-POS)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$25.00 | $50.00 | Q:1 /30Days | $279.65 |
Browse Plan Formulary |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$35.00 | $70.00 | Q:1 /30Days | $284.00 |
Browse Plan Formulary |
Coventry Summit Select (HMO-POS)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$30.00 | $60.00 | Q:1 /30Days | $289.07 |
Browse Plan Formulary |
Coventry Vista Prime (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$20.00 | $40.00 | Q:1 /30Days | $288.76 |
Browse Plan Formulary |
Humana Gold Plus H1036-062C (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | None | $272.21 |
Browse Plan Formulary |
Humana Gold Plus H1036-199 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $272.21 |
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 |
Humana Gold Plus SNP-CVD/CHF H1036-190 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | None | $272.21 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-130C (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$35.00 | $95.00 | None | $272.21 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $271.56 |
Browse Plan Formulary |
PUP EASY (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$45.00 | $115.00 | Q:135 /30Days | $270.87 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$90.00 | $270.00 | Q:135 /30Days | $270.83 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$40.00 | $120.00 | Q:2 /30Days | $279.91 |
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 |
WellCare Dividend (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Preferred Brand |
$20.00 | $40.00 | None | $276.69 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$25.00 | $50.00 | None | $275.68 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 | to be determined | 3 |
Tier 3 |
$0.00 | $0.00 | Q:135 /30Days | $271.06 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | Q:2 /30Days | $279.91 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $276.13 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$8.70 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $276.18 |
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 |
WellCare Access (HMO SNP)
|
$12.10 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $276.18 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-104A (HMO SNP)
|
$16.50 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | None | $272.21 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325* | to be determined | 2* |
Tier 2 |
$0.00 | $0.00 | Q:2 /30Days | $269.52 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-152 (HMO SNP)
|
$22.30 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | None | $272.21 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$23.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $271.07 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 | to be determined | 2 |
Tier 2 |
$45.00 | $45.00 | None | $274.39 |
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 |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 | Some Generics | 3 |
Preferred Brand |
25% | 25% | Q:2 /30Days | $271.17 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | None | $272.21 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
$45.00 | $125.00 | None | $272.21 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 | to be determined | 4 |
Tier 4 |
15% | 15% | None | $270.96 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$25.50 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:1 /30Days | $289.41 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$40.00 | $110.00 | None | $271.56 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$33.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $90.00 | None | $272.83 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 | Few Generics, Few Brands | 2 |
Preferred Brand |
$43.00 | $119.00 | None | $271.33 |
Browse Plan Formulary |
Day Break (HMO)
|
$68.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$60.00 | $180.00 | Q:2 /30Days | $279.91 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $271.61 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$152.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:1 /30Days | $272.27 |
Browse Plan Formulary |
HumanaChoice H5415-067 (PPO)
|
$152.00 |
$0 | Few Generics, Few Brands | 2 |
Preferred Brand |
$40.00 | $110.00 | None | $272.21 |
Browse Plan Formulary |