ANDRODERM 2 MG/24HR PATCH (60 EA ) (NDC: 52544007660)
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% | Q:34 /34Days | $365.40 |
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% | Q:34 /34Days | $376.11 |
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% | Q:34 /34Days | $373.86 |
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% | Q:34 /34Days | $367.52 |
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% | Q:34 /34Days | $404.91 |
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 |
3 |
Non-Preferred Brand |
$64.00 | $128.00 | Q:30 /30Days | $363.31 |
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 | $367.09 |
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 | $373.86 |
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 | $373.86 |
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 | $365.40 |
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 | $404.91 |
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-Advantage D-SNP (HMO SNP)
|
$23.60 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
15% | 15% | Q:30 /30Days | $363.31 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$32.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | P | $367.65 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $365.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $404.91 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $367.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $373.86 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$56.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
25% | 25% | None | $373.86 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $373.86 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $367.52 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $404.91 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $365.40 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$78.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | Q:34 /34Days | $376.11 |
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 1 (HMO-POS)
|
$79.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$74.00 | $148.00 | Q:30 /30Days | $363.31 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$89.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$35.00 | $87.50 | P | $367.65 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$97.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$40.00 | $100.00 | P | $367.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $373.86 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $404.91 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $365.40 |
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)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $367.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$123.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $112.50 | None | $373.86 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantageHMO-POS Option 2 (HMO-POS)
|
$125.00 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
$70.00 | $140.00 | Q:30 /30Days | $363.31 |
Browse Plan Formulary |
HealthPlus MedicarePlus-AdvantagePPO Enhanced (PPO)
|
$136.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
$70.00 | $140.00 | Q:30 /30Days | $363.85 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $373.86 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $373.86 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $365.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $365.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$194.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$40.00 | $100.00 | None | $367.09 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $367.52 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $404.91 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $365.40 |
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)
|
$200.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $376.11 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$200.00 |
$0 |
Many Generics |
3 |
Preferred Brand |
$35.00 | $87.50 | Q:34 /34Days | $373.86 |
Browse Plan Formulary |