ATROVENT HFA AER 17MCG (12.9 GRAMS PER 200 ACT CAN) (NDC: 00597008717)
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% | None | $225.28 |
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% | None | $224.81 |
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% | None | $225.21 |
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% | None | $225.79 |
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% | None | $226.92 |
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 | Q:26 /30Days | $220.81 |
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% | None | $224.93 |
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% | None | $224.71 |
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% | None | $225.64 |
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% | None | $225.69 |
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% | None | $226.92 |
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 | 3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $223.82 |
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% | Q:26 /30Days | $220.86 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$32.70 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:26 /30Days | $220.76 |
Browse Plan Formulary |
Meridian Advantage Plan of Michigan (HMO SNP)
|
$34.10 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
n/a | n/a | None | $157.76 |
Browse Plan Formulary |
CareSource Advantage (HMO SNP)
|
$34.20 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:26 /30Days | $222.26 |
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 | $221.45 |
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 R5826-006 (Regional PPO)
|
$37.50 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | Q:30 /30Days | $223.82 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$44.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $234.31 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$54.00 |
$50 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $234.31 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$55.60 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | None | $224.59 |
Browse Plan Formulary |
Humana Gold Plus H8908-001 (HMO)
|
$59.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | Q:30 /30Days | $224.06 |
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 | Q:26 /30Days | $220.81 |
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 | 3 |
Tier 3 |
25% | 25% | None | $224.93 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $224.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $225.64 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $225.69 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$86.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 3 |
Tier 3 |
25% | 25% | None | $226.92 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO-POS)
|
$94.00 |
$25 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $234.31 |
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 | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $224.59 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $224.49 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$97.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $224.44 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$103.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $234.24 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $224.81 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $225.21 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $225.79 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $226.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$113.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $225.28 |
Browse Plan Formulary |
HAP Senior Plus - Henry Ford (HMO)
|
$122.00 |
$50 | All Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $234.31 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS)
|
$125.00 |
$0 | All Generics | 2 |
Preferred Brand |
$35.00 | $70.00 | Q:26 /30Days | $220.81 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $224.93 |
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 | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $224.71 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $225.64 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $225.69 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$125.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $226.92 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$136.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$35.00 | $87.50 | None | $224.59 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$154.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | None | $224.59 |
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 | 3 |
Preferred Brand |
$45.00 | $112.50 | None | $234.31 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
|
$174.00 |
$50 | All Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $234.24 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $226.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $225.79 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $225.21 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$218.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $224.81 |
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 | 3 |
Preferred Brand |
$35.00 | $87.50 | None | $225.28 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $224.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $224.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $225.45 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $225.21 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$244.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$40.00 | $100.00 | None | $225.79 |
Browse Plan Formulary |