AMLODIPINE BESYLATE 5MG TABLET (90 CT) (90 BOT) (NDC: 65862010290)
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 | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $4.99 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $4.99 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.99 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.99 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$7.00 | $14.00 | Q:1 /1Days | $7.31 |
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 |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$7.00 | $14.00 | Q:1 /1Days | $7.31 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$4.00 | $6.00 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$4.00 | $6.00 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$7.00 | $10.50 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$7.00 | $10.50 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$5.00 | $10.00 | None | $5.05 |
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 |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$5.00 | $10.00 | None | $5.05 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.05 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Generic |
$5.00 | $10.00 | None | $4.10 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Generic |
$5.00 | $10.00 | None | $4.10 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.86 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.86 |
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 TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.86 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $3.86 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$325* | All Generics, Few Brands | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$325* | All Generics, Few Brands | 1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
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 ESRD (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
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 Touch (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | All Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | All Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days | $3.60 |
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 |
Central Health Premier Plan (HMO)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | 25% | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | 25% | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Generic |
$0.00 | $0.00 | None | $9.16 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Generic |
$0.00 | $0.00 | None | $9.16 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.12 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.12 |
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 |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.10 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.10 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.10 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.10 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO) (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | Q:62 /31Days | $5.00 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.56 |
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 |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.56 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $6.56 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $6.56 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.56 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $6.56 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $6.56 |
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 |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $6.56 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.18 |
Browse Plan Formulary |
Heart First (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.18 |
Browse Plan Formulary |
Humana Gold Plus H0108-011 (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.00 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | Some Generics | 1 |
Preferred Generic |
$4.00 | $8.00 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$8.00 | $24.00 | Q:30 /30Days | $3.60 |
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 |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $29.85 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $29.85 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $29.58 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $29.58 |
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 | $3.86 |
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 | $3.86 |
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 Balance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.18 |
Browse Plan Formulary |
SCAN Balance (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $13.18 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $13.18 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $13.18 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $13.18 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO SNP)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $13.18 |
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 |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $12.50 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$5.00 | $12.50 | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$10.00 | $20.00 | None | $29.85 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$10.00 | $20.00 | None | $29.85 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$23.90 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $6.56 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $4.99 |
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 |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $4.99 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H0108-015 (HMO SNP)
|
$27.30 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $5.00 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$28.00 |
$90* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$6.00 | $9.00 | Q:45 /30Days | $24.64 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$28.00 |
$90* | No additional gap coverage, only the Donut Hole Discount | 1* |
Preferred Generic |
$6.00 | $9.00 | Q:45 /30Days | $24.64 |
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% | None | $4.10 |
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% | None | $4.10 |
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 |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $4.10 |
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% | None | $4.10 |
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% | None | $4.10 |
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% | None | $4.10 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325* | Few Generics | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.86 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325* | Few Generics | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.86 |
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 |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $6.56 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $6.56 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $6.57 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | None | $6.57 |
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:45 /30Days | $7.19 |
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:45 /30Days | $7.19 |
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 |
Central Health Medi-Medi Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | 25% | Q:30 /30Days | $3.60 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | 25% | Q:30 /30Days | $3.60 |
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 | None | $4.04 |
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 | None | $4.04 |
Browse Plan Formulary |
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 | None | $4.04 |
Browse Plan Formulary |
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 | None | $4.04 |
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 Connections (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $13.18 |
Browse Plan Formulary |
SCAN Connections (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $13.18 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $13.18 |
Browse Plan Formulary |
SCAN Connections at Home (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | None | $13.18 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$39.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$3.00 | $6.00 | None | $6.56 |
Browse Plan Formulary |
Humana Gold Plus H0108-012 (HMO-POS)
|
$49.00 |
$0 | Few Generics, Few Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.00 |
Browse Plan Formulary |