AMITRIPTYLINE HCL 150 MG TAB (100 EA BOT) (NDC: 00603221721)
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 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $5.90 |
Browse Plan Formulary |
Abrazo Advantage (HMO)
|
$0.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $30.00 | None | $11.16 |
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 | None | $14.49 |
Browse Plan Formulary |
Blue Medicare Advantage Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
22% | 25% | None | $5.06 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $5.85 |
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 Diabetes (HMO SNP)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $5.85 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $5.85 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $5.85 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
All Generics, Few Brands |
2 |
Non-Preferred Generic |
$5.00 | $12.50 | None | $5.85 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Diabetes Heart (HMO SNP)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $8.73 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Standard (HMO)
|
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $8.73 |
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 Jade (HMO SNP)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.16 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $4.16 |
Browse Plan Formulary |
Health Net Ruby Select (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.16 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.58 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (HMO)
|
$0.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.58 |
Browse Plan Formulary |
SCAN Classic (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $8.42 |
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 |
2 |
Non-Preferred Generic |
$10.00 | $25.00 | None | $5.85 |
Browse Plan Formulary |
Blue Medicare Advantage Plus (HMO)
|
$14.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$4.00 | $12.00 | None | $5.06 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (Regional PPO)
|
$23.10 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $5.58 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Premium (HMO)
|
$25.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$5.00 | $10.00 | None | $8.73 |
Browse Plan Formulary |
Advantage by Bridgeway Health Solutions (HMO SNP)
|
$27.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $6.97 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
|
$27.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $13.32 |
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 |
Mercy Care Advantage (HMO SNP)
|
$27.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $13.32 |
Browse Plan Formulary |
Mercy Care Advantage (HMO SNP)
|
$27.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $13.32 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$27.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $5.93 |
Browse Plan Formulary |
Cigna Medicare Select Plus Rx-Dual (HMO SNP)
|
$28.00 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $8.73 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO SNP)
|
$28.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $5.93 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO SNP)
|
$28.20 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $5.93 |
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)
|
$29.30 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $5.84 |
Browse Plan Formulary |
Abrazo Advantage Plus (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $11.16 |
Browse Plan Formulary |
Health Choice Generations (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $7.63 |
Browse Plan Formulary |
Health Choice Generations (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $7.60 |
Browse Plan Formulary |
Health Net Amber (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.16 |
Browse Plan Formulary |
ONECare by Care1st Health Plan Arizona, Inc. (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | n/a | None | $6.91 |
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 |
SCAN Connections (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
n/a | n/a | None | $8.42 |
Browse Plan Formulary |
University Care Advantage (HMO SNP)
|
$29.40 |
$325 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $6.91 |
Browse Plan Formulary |
Blue Medicare Advantage Premier (HMO)
|
$45.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
$4.00 | $12.00 | None | $5.06 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$49.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$3.00 | $6.00 | None | $4.16 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (HMO-POS)
|
$62.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.58 |
Browse Plan Formulary |
Humana Reader''s Digest Healthy Living Plan (PPO)
|
$102.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.58 |
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 Reader''s Digest Healthy Living Plan (Regional PPO)
|
$142.10 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.58 |
Browse Plan Formulary |
Humana Gold Choice H8145-103 (PFFS)
|
$177.00 |
$0 |
Few Generics, Few Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | P | $5.58 |
Browse Plan Formulary |