ABILIFY 10MG TABLET (30 BOT) (NDC: 59148000813)
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 (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $799.48 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $799.65 |
Browse Plan Formulary |
AARP MedicareComplete Choice Plan 2 (Regional PPO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $798.02 |
Browse Plan Formulary |
BlueMedicare HMO LifeTime (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$35.00 | $105.00 | Q:30 /30Days | $795.90 |
Browse Plan Formulary |
BlueMedicare HMO PrimeTime (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $795.90 |
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 Regional PPO (Regional PPO)
|
$0.00 |
$30 | No additional gap coverage, only the Donut Hole Discount | 3 |
Preferred Brand |
$45.00 | $135.00 | Q:30 /30Days | $795.54 |
Browse Plan Formulary |
Day Break (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$60.00 | $180.00 | Q:90 /30Days | $817.12 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $808.34 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$90.00 | $180.00 | S Q:30 /30Days | $808.57 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $808.89 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $808.89 |
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 |
Freedom VIP Savings (HMO SNP)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $808.89 |
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 |
$80.00 | $160.00 | S Q:30 /30Days | $808.89 |
Browse Plan Formulary |
Humana Gold Plus H1036-067 (HMO)
|
$0.00 |
$0 | Some Generics, Few Brands | 4 |
Non-Preferred Brand |
$55.00 | $155.00 | Q:30 /30Days | $785.95 |
Browse Plan Formulary |
Humana Gold Plus H1036-141 (HMO)
|
$0.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$60.00 | $170.00 | Q:30 /30Days | $786.33 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-160 (HMO SNP)
|
$0.00 |
$0 | Some Generics, Few Brands | 4 |
Non-Preferred Brand |
$60.00 | $170.00 | Q:30 /30Days | $786.33 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$0.00 |
$150 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $785.40 |
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 |
Optimum Diamond Rewards (HMO-POS SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $809.09 |
Browse Plan Formulary |
Optimum Diamond Rewards COPD (HMO-POS SNP)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$69.00 | $138.00 | S Q:30 /30Days | $809.09 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$60.00 | $120.00 | S Q:30 /30Days | $808.83 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO-POS)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 3 |
Non-Preferred Brand |
$80.00 | $160.00 | S Q:30 /30Days | $808.52 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
|
$0.00 |
$0 | Many Generics | 3 |
Non-Preferred Brand |
$69.00 | $138.00 | S Q:30 /30Days | $808.52 |
Browse Plan Formulary |
Preferred Secure Option (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
33% | 33% | Q:30 /30Days | $799.49 |
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 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | n/a | S Q:30 /30Days | $778.96 |
Browse Plan Formulary |
Simply Level (HMO SNP)
|
$0.00 |
$0 | Many Generics, Few Brands | 4 |
Non-Preferred Brand |
$55.00 | n/a | S Q:30 /30Days | $779.08 |
Browse Plan Formulary |
Simply More (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$55.00 | n/a | S Q:30 /30Days | $778.96 |
Browse Plan Formulary |
Sunrise (HMO)
|
$0.00 |
$0 | All Generics | 3 |
Non-Preferred Brand |
$40.00 | $120.00 | Q:90 /30Days | $817.12 |
Browse Plan Formulary |
Ultimate Premier (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$20.00 | $40.00 | None | $793.30 |
Browse Plan Formulary |
Ultimate Premier Plus (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Preferred Brand |
$10.00 | $20.00 | None | $793.30 |
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-DE H1036-102 (HMO SNP)
|
$8.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $786.47 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
|
$9.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$88.00 | $176.00 | Q:31 /31Days | $811.75 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$10.40 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$84.00 | $168.00 | Q:31 /31Days | $811.75 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-161 (HMO SNP)
|
$10.90 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $786.47 |
Browse Plan Formulary |
WellCare Select (HMO SNP)
|
$11.60 |
$310 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$88.00 | $176.00 | Q:31 /31Days | $811.17 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete LP (HMO SNP)
|
$17.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $799.58 |
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 |
UnitedHealthcare Nursing Home Plan (PPO SNP)
|
$19.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
25% | 25% | Q:30 /30Days | $798.77 |
Browse Plan Formulary |
Advantage by Sunshine Health (HMO SNP)
|
$21.00 |
$310 | No additional gap coverage, only the Donut Hole Discount | 2 |
Preferred Brand |
$45.00 | $45.00 | Q:30 /30Days | $804.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
|
$21.80 |
$310 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | Q:30 /30Days | $798.02 |
Browse Plan Formulary |
Freedom Medi-Medi Full (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | S Q:30 /30Days | $808.90 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $808.90 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | S Q:30 /30Days | $808.85 |
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 |
Optimum Emerald Partial (HMO SNP)
|
$22.10 |
$310 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
15% | 15% | S Q:30 /30Days | $808.85 |
Browse Plan Formulary |
Simply Care (HMO SNP)
|
$22.10 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$90.00 | n/a | S Q:30 /30Days | $779.08 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
|
$22.10 |
$0 | Many Generics | 4 |
Non-Preferred Brand |
$90.00 | n/a | S Q:30 /30Days | $779.08 |
Browse Plan Formulary |
Simply Complete (HMO SNP)
|
$22.10 |
$310 | Many Generics | 4 |
Non-Preferred Brand |
$90.00 | n/a | S Q:30 /30Days | $779.08 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$36.60 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$85.00 | $245.00 | Q:30 /30Days | $785.40 |
Browse Plan Formulary |
Humana Gold Choice H8145-061 (PFFS)
|
$103.00 |
$0 | Few Generics, Few Brands | 4 |
Non-Preferred Brand |
$95.00 | $275.00 | Q:30 /30Days | $785.48 |
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 PPO (PPO)
|
$127.00 |
$0 | Many Generics | 3 |
Preferred Brand |
$30.00 | $90.00 | Q:30 /30Days | $796.40 |
Browse Plan Formulary |