PHENYTOIN SOD EXT 200 MG CAP (30 EA ) (NDC: 62756029983)
2014 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 | 2 |
Non-Preferred Generic |
$8.00 | $16.00 | None | $18.36 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 | Few Generics | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $18.25 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 | Few Generics | 1 |
Generic |
$10.00 | $20.00 | None | $20.03 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $19.07 |
Browse Plan Formulary |
AvMed Medicare Choice (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$4.00 | $0.00 | None | $20.70 |
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 |
BlueMedicare HMO LifeTime (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $18.86 |
Browse Plan Formulary |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$2.00 | $6.00 | None | $18.86 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$0.00 |
$30 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$10.00 | $30.00 | None | $19.01 |
Browse Plan Formulary |
CareDirect (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
CareFree PLUS (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
CareHeart (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
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 |
CareOne (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
|
$0.00 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $19.75 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $20.28 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $20.28 |
Browse Plan Formulary |
Day Break (HMO)
|
$0.00 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $19.75 |
Browse Plan Formulary |
Healthy Advantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Non-Preferred Generic |
$0.00 | n/a | None | $19.89 |
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 H1036-065C (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
Humana Gold Plus H1036-224 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$150* | Few Generics, Few Brands | 2* |
Non-Preferred Generic |
$15.00 | $0.00 | None | $25.15 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | n/a | None | $18.25 |
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 |
PHP (HMO SNP)
|
$0.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
25% | n/a | None | $21.04 |
Browse Plan Formulary |
Preferred Choice Broward (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $18.25 |
Browse Plan Formulary |
Simply Clear (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
25% | n/a | None | $21.27 |
Browse Plan Formulary |
Simply Extra (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $21.26 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $21.26 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $21.26 |
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 Options (HMO-POS)
|
$0.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $21.26 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$0.00 | n/a | None | $19.89 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 2 |
Non-Preferred Generic |
$0.00 | n/a | None | $19.89 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $19.75 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-185 (HMO SNP)
|
$7.70 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
|
$8.00 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
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 |
WellCare Liberty (HMO SNP)
|
$9.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$4.00 | $8.00 | None | $21.41 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$10.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$7.00 | $14.00 | None | $21.41 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
|
$10.50 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
WellCare Select (HMO SNP)
|
$11.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Non-Preferred Generic |
$4.00 | $8.00 | None | $21.41 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
|
$11.70 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
|
$17.00 |
$310* | No additional gap coverage, only the Donut Hole Discount | 2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $25.05 |
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 |
Coventry Summit Maximum (HMO SNP)
|
$18.90 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $20.22 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$19.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | None | $18.52 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)
|
$20.60 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | n/a | None | $18.00 |
Browse Plan Formulary |
Advantage by Sunshine Health (HMO SNP)
|
$21.00 |
$310* | Many Generics | 1* |
Generic |
$0.00 | $0.00 | None | $20.67 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO-POS SNP)
|
$21.20 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $18.00 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$21.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | None | $18.36 |
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 |
Molina Medicare Options Plus (HMO SNP)
|
$22.00 |
$310* | Many Generics, Few Brands | 1* |
Generic |
$0.00 | $0.00 | None | $19.07 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
|
$22.10 |
$310 | Some Generics | 2 |
Non-Preferred Generic |
25% | 25% | None | $19.07 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
|
$22.10 |
$0 | No additional gap coverage, only the Donut Hole Discount | 1 |
Preferred Generic |
$0.00 | $0.00 | None | $20.22 |
Browse Plan Formulary |
MediMax (HMO)
|
$22.10 |
$310 | Call plan for details | 2 |
Non-Preferred Generic |
25% | n/a | None | $19.82 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$22.10 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | n/a | None | $21.26 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$22.10 |
$0 | Many Generics | 1 |
Preferred Generic |
$0.00 | n/a | None | $21.26 |
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 Complete (HMO SNP)
|
$22.10 |
$310* | Many Generics | 1* |
Preferred Generic |
$0.00 | $0.00 | None | $21.26 |
Browse Plan Formulary |
Touch Institutional Special Needs Plan (HMO SNP)
|
$22.10 |
$310 | Some Generics | 2 |
Non-Preferred Generic |
25% | 25% | None | $19.07 |
Browse Plan Formulary |
Sunny Days (HMO SNP)
|
$33.90 |
$0 | All Generics | 1 |
Generic |
$0.00 | $0.00 | None | $19.75 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$35.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Generic |
$4.00 | $8.00 | None | $20.03 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$36.60 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$8.00 | $0.00 | None | $25.15 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
|
$45.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$10.00 | $0.00 | None | $25.00 |
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 Choice H8145-061 (PFFS)
|
$103.00 |
$0 | Few Generics, Few Brands | 2 |
Non-Preferred Generic |
$15.00 | $0.00 | None | $25.18 |
Browse Plan Formulary |
BlueMedicare PPO (PPO)
|
$127.00 |
$0 | Many Generics | 1 |
Preferred Generic |
$2.00 | $6.00 | None | $19.07 |
Browse Plan Formulary |