ALBENZA 200 MG TABLET (2 EA ) (NDC: 52054055022)
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 | 4 |
Tier 4 |
25% | 25% | None | $6,252.61 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,162.35 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,305.63 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,247.70 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,162.35 |
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 | None | $6,095.31 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,252.61 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,162.35 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,277.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,247.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$12.50 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,343.57 |
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% | None | $6,155.12 |
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% | None | $6,095.61 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$37.50 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | None | $6,155.12 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$43.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | None | $6,191.79 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$47.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $6,191.79 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$47.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $6,163.22 |
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)
|
$47.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $112.50 | None | $6,188.15 |
Browse Plan Formulary |
HumanaChoice H5470-005 (PPO)
|
$62.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$90.00 | $260.00 | None | $6,137.52 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,247.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,343.57 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,277.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,162.35 |
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)
|
$76.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Tier 4 |
25% | 25% | None | $6,252.61 |
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 | None | $6,095.31 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $6,162.35 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $6,247.70 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $6,305.63 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$96.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $6,162.35 |
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)
|
$96.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$80.00 | $200.00 | None | $6,252.61 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$107.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$35.00 | $87.50 | None | $6,191.79 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$111.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$40.00 | $100.00 | None | $6,191.79 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS)
|
$125.00 |
$0 | All Generics | 2 |
Preferred Brand |
$35.00 | $70.00 | None | $6,095.31 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,277.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,252.61 |
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)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,343.57 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,247.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$132.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,162.35 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantagePPO Enhanced (PPO)
|
$136.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$35.00 | $70.00 | None | $6,096.34 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $6,247.70 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $6,305.63 |
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)
|
$213.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $6,162.35 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $6,252.61 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$213.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$75.00 | $187.50 | None | $6,162.35 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,252.61 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,162.35 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,277.38 |
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 Assure (PPO)
|
$240.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,247.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$240.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$95.00 | $237.50 | None | $6,345.44 |
Browse Plan Formulary |