ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT) (60 BOT) (NDC: 00603233820)
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 2 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $21.17 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $20.57 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $14.00 | Q:13 /1Days | $17.20 |
Browse Plan Formulary |
Humana Gold Plus H5291-001 (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
Humana Gold Plus H5291-002 (HMO)
|
$0.00 |
$325 |
Few Generics |
3 |
Preferred Brand |
15% | 15% | Q:390 /30Days | $15.89 |
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 H5291-002 (HMO)
|
$0.00 |
$325 |
Few Generics |
3 |
Preferred Brand |
15% | 15% | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Core (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $40.12 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Core (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $22.48 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$9.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $20.57 |
Browse Plan Formulary |
HumanaChoice H0623-011 (PPO)
|
$12.80 |
$325 |
Few Generics |
3 |
Preferred Brand |
18% | 18% | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Silver (HMO)
|
$18.10 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $40.12 |
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 H5291-001 (HMO)
|
$27.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Plus Choice (HMO-POS)
|
$27.30 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $40.12 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$28.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $20.79 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$28.50 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $20.79 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$29.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $20.77 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$29.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $20.77 |
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 |
HumanaChoice H0623-001 (PPO)
|
$29.80 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
SureValue Select (HMO)
|
$31.10 |
$60* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$10.00 | $15.00 | Q:390 /30Days | $28.96 |
Browse Plan Formulary |
Humana Gold Choice H8145-123 (PFFS)
|
$31.30 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
Colorado Access Advantage Peak Plan (HMO)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $14.00 | None | $25.06 |
Browse Plan Formulary |
Colorado Access Advantage Summit Plan (HMO SNP)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.50 | $15.00 | None | $25.06 |
Browse Plan Formulary |
Senior Advantage Medicare Medicaid Plan (HMO SNP)
|
$31.90 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $40.12 |
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 Select Plan (PPO)
|
$38.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$7.00 | $14.00 | Q:13 /1Days | $17.20 |
Browse Plan Formulary |
HumanaChoice H0623-011 (PPO)
|
$39.00 |
$325 |
Few Generics |
3 |
Preferred Brand |
18% | 18% | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$40.00 |
$0 |
Some Generics |
2 |
Non-Preferred Generic |
$6.00 | $12.00 | None | $21.17 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$40.50 |
$90 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $15.00 | Q:390 /30Days | $28.96 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Silver (HMO)
|
$44.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $22.48 |
Browse Plan Formulary |
Rocky Mountain Thrifty Plan + Rx (Cost)
|
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $28.32 |
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 |
Rocky Mountain Green Plan + Rx (Cost)
|
$51.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$13.00 | $39.00 | None | $28.32 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$53.00 |
$90 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $15.00 | Q:390 /30Days | $28.96 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage Gold (HMO)
|
$55.70 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $40.12 |
Browse Plan Formulary |
Rocky Mountain Green Plan + Rx (Cost)
|
$56.00 |
$125* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Non-Preferred Generic |
$13.00 | $39.00 | None | $28.32 |
Browse Plan Formulary |
HumanaChoice H0623-001 (PPO)
|
$70.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$42.00 | $116.00 | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
Rocky Mountain Thrifty Plan + Rx (Cost)
|
$74.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $28.32 |
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 |
Rocky Mountain Standard Plan + Rx (Cost)
|
$77.70 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $28.32 |
Browse Plan Formulary |
Humana Gold Choice H8145-123 (PFFS)
|
$81.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:390 /30Days | $15.89 |
Browse Plan Formulary |
Rocky Mountain Plus Plan + Rx (Cost)
|
$102.80 |
$0 |
All Generics |
2 |
Non-Preferred Generic |
$9.00 | $22.50 | None | $28.32 |
Browse Plan Formulary |
Rocky Mountain Standard Plan + Rx (Cost)
|
$103.50 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$12.00 | $30.00 | None | $28.32 |
Browse Plan Formulary |
Rocky Mountain Plus Plan + Rx (Cost)
|
$249.80 |
$0 |
All Generics |
2 |
Non-Preferred Generic |
$9.00 | $22.50 | None | $28.32 |
Browse Plan Formulary |