Lorazepam 0.5mg/1 500 TABLET BOTTLE (500 TABLET in 1 BOTTLE ) (NDC: 00378232105)
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 Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $13.67 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $13.67 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$5.00 | $10.00 | Q:600 /30Days | $9.62 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:600 /30Days | $9.62 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Generic |
$5.00 | $10.00 | Q:90 /30Days | $9.78 |
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 |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:120 /30Days | $9.89 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:120 /30Days | $9.89 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | Q:120 /30Days | $9.89 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:120 /30Days | $11.25 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$325* | All Generics, Few Brands | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | Q:120 /30Days | $11.25 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:120 /30Days | $11.25 |
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 |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:120 /30Days | $11.25 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:120 /30Days | $11.25 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:120 /30Days | $11.25 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$5.00 | $12.50 | Q:120 /30Days | $11.25 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $9.78 |
Browse Plan Formulary |
Easy Choice Value Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $9.78 |
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 |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $9.78 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $9.78 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $14.48 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $14.48 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $14.48 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $14.48 |
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 |
Heart First (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | P | $27.02 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$8.00 | $16.00 | None | $16.60 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $16.64 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $16.60 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | n/a | None | $10.29 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 2 |
Non-Preferred Generic |
$5.00 | $10.00 | P | $27.02 |
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 |
SCAN Classic (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$8.00 | $16.00 | P | $27.02 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$8.00 | $16.00 | P | $27.02 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $25.00 | Q:120 /30Days | $11.25 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $16.60 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan North (HMO SNP)
|
$16.60 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $16.64 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$23.90 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $14.48 |
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 |
SCAN Options (HMO)
|
$25.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | P | $27.96 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $13.67 |
Browse Plan Formulary |
Health Net Ruby Select (HMO)
|
$29.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$12.00 | $24.00 | None | $14.48 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:90 /30Days | $9.78 |
Browse Plan Formulary |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | Q:90 /30Days | $9.78 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
25% | 25% | Q:90 /30Days | $9.78 |
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 |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325 | Few Generics | 2 |
Non-Preferred Generic |
25% | 25% | Q:120 /30Days | $9.89 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $14.48 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $14.48 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$29.80 |
$325* | No additional gap coverage, only the Donut Hole Discount | 1* |
Generic |
$0.00 | $0.00 | Q:600 /30Days | $9.99 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$29.90 |
$325* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
25% | 25% | Q:90 /30Days | $9.78 |
Browse Plan Formulary |
Freedom Plan (HMO SNP)
|
$29.90 |
$325* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:90 /30Days | $9.78 |
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 |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | Q:90 /30Days | $9.75 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | P | $27.02 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | P | $27.96 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | P | $27.02 |
Browse Plan Formulary |
Humana Gold Plus H0108-022 (HMO)
|
$32.00 |
$0 | Few Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:90 /30Days | $5.61 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$39.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | P | $27.96 |
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 H0108-021 (HMO)
|
$62.00 |
$0 | Some Generics, Few Brands | 3 |
Preferred Brand |
$45.00 | $125.00 | Q:90 /30Days | $5.61 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO)
|
$75.00 |
$0 | All Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $16.64 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby (HMO)
|
$182.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $14.48 |
Browse Plan Formulary |