BYETTA 5MCG/0.02ML PEN INJ (1.2 ML PEN PKGCOM) (NDC: 66780021007)
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 Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $125.00 | None | $362.95 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 3 |
Preferred Brand |
$0.00 | $0.00 | None | $362.88 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$0.00 | $0.00 | None | $362.88 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $364.23 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$80.00 | $160.00 | P Q:1 /30Days | $363.08 |
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 |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 3 |
Preferred Brand |
$25.00 | $75.00 | Q:5 /30Days | $367.78 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$40.00 | $110.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$25.00 | $65.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
CareOne PLUS (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$25.00 | $65.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$20.00 | $60.00 | Q:2 /30Days | $374.86 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO-POS)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$25.00 | $75.00 | P Q:1 /30Days | $376.71 |
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 |
Coventry Summit Plus (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$50.00 | $150.00 | P Q:1 /30Days | $376.71 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$20.00 | $60.00 | P Q:1 /30Days | $376.71 |
Browse Plan Formulary |
Day Break (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$20.00 | $60.00 | Q:2 /30Days | $374.86 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S | $368.79 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S | $368.66 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S | $368.66 |
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 Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S | $368.66 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S | $368.66 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
25% | n/a | None | $378.84 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$25.00 | $65.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Humana Gold Plus H1036-164 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$40.00 | $110.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$25.00 | $65.00 | S Q:3 /30Days | $360.58 |
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 SNP-DB H1036-188 (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$25.00 | $65.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$0.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | S Q:3 /30Days | $362.79 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
|
$0.00 |
$0 | All Generics | 2 |
Brand |
$0.00 | n/a | None | $364.95 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$20.00 | n/a | None | $384.38 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Chronic Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$20.00 | n/a | None | $384.38 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$40.00 | n/a | None | $384.34 |
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 |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$69.00 | $138.00 | S | $368.45 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S | $368.45 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
25% | n/a | P | $367.77 |
Browse Plan Formulary |
Preferred Medical Plan Choice (HMO)
|
$0.00 |
$0 | Many Generics, Some Brands | 3 |
Preferred Brand |
$0.00 | $0.00 | S Q:1 /28Days | $366.86 |
Browse Plan Formulary |
Preferred Medical Plan Value (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$25.00 | $75.00 | S Q:1 /28Days | $366.86 |
Browse Plan Formulary |
PUP REWARDS (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$15.00 | $25.00 | S Q:1 /30Days | $362.92 |
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 |
Simply Extra (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$45.00 | n/a | Q:5 /28Days | $373.59 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$15.00 | n/a | Q:5 /28Days | $373.59 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 4 |
Non-Preferred Brand |
$10.00 | n/a | Q:5 /28Days | $373.59 |
Browse Plan Formulary |
Simply Options (HMO-POS)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$30.00 | n/a | Q:5 /28Days | $373.59 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 3 |
Preferred Brand |
$0.00 | n/a | None | $378.84 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 3 |
Preferred Brand |
$0.00 | n/a | None | $378.84 |
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 |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$20.00 | $60.00 | Q:2 /30Days | $374.86 |
Browse Plan Formulary |
WellCare Choice (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 3 |
Non-Preferred Brand |
$30.00 | $60.00 | None | $367.87 |
Browse Plan Formulary |
WellCare Dividend (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$49.00 | $98.00 | None | $367.87 |
Browse Plan Formulary |
PUP EXTRA (HMO SNP)
|
$4.90 |
$0 | to be determined | 2 |
Tier 2 |
$0.00 | $0.00 | S Q:1 /30Days | $362.99 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$4.90 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | Q:2 /30Days | $374.86 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
|
$8.50 |
$325 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | None | $368.63 |
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 |
WellCare Liberty (HMO SNP)
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $367.87 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$12.20 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $367.87 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
|
$17.90 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$76.00 | $228.00 | P Q:1 /30Days | $379.17 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$18.70 |
$325 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | P Q:1 /30Days | $361.36 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$20.30 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | S Q:3 /30Days | $360.58 |
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 SNP-I H1036-187 (HMO SNP)
|
$21.30 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
|
$21.90 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$23.10 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | S | $368.88 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO SNP)
|
$23.40 |
$325 | to be determined | 3 |
Tier 3 |
35% | n/a | None | $384.34 |
Browse Plan Formulary |
Sunshine State Health Plan (HMO SNP)
|
$24.00 |
$325 | to be determined | 3 |
Tier 3 |
$95.00 | $95.00 | P | $367.41 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$24.70 |
$325 | Some Generics | 4 |
Non-Preferred Brand |
25% | 25% | P Q:1 /30Days | $363.08 |
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 |
Coventry Vista Maximum (HMO SNP)
|
$24.70 |
$0 | to be determined | 3 |
Tier 3 |
$76.00 | $228.00 | P Q:1 /30Days | $379.17 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$24.70 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | S | $368.88 |
Browse Plan Formulary |
MediMax (HMO)
|
$24.70 |
$325* | No additional gap coverage, only the Donut Hole Discount | 3* |
Preferred Brand |
25% | n/a | None | $376.73 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$24.80 |
$325 | to be determined | 4 |
Tier 4 |
$95.00 | $275.00 | S Q:3 /30Days | $360.58 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
n/a | n/a | S | $368.83 |
Browse Plan Formulary |
Optimum Emerald Partial (HMO SNP)
|
$24.80 |
$325 | to be determined | 1 |
Tier 1 |
15% | 15% | S | $368.83 |
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 |
Simply Care (HMO SNP)
|
$24.80 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$25.00 | n/a | Q:5 /28Days | $372.87 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$24.80 |
$0 | to be determined | 4 |
Tier 4 |
$75.00 | n/a | Q:5 /28Days | $373.59 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$24.80 |
$325 | to be determined | 3 |
Tier 3 |
15% | 15% | None | $362.95 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$25.50 |
$0 | to be determined | 3 |
Tier 3 |
$76.00 | $228.00 | P Q:1 /30Days | $379.97 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$25.80 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$25.00 | n/a | Q:5 /28Days | $372.87 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$28.10 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $245.00 | S Q:3 /30Days | $362.79 |
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 Premier Plan (PPO)
|
$33.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $364.70 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$42.00 |
$0 | Few Generics, Few Brands | 3 |
Non-Preferred Brand |
$80.00 | $230.00 | S Q:3 /30Days | $362.23 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$102.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | S Q:3 /30Days | $362.79 |
Browse Plan Formulary |